Patient Forms

We ask that you fill out forms before your next visit to Capital Vision Center in Concord NH

Please bring your Medical Insurance Cards and Vision Benefit Plan information as well as your current medication list, eyeglasses, sunglasses, computer glasses, and any contact lens information with you to your appointment.

 

OPTION 1: Digital Forms. Use the link below to fill out forms electronically on any device and they will be automatically securely uploaded to us at the completion of the final form. Signed forms will be available for you to download if you want them for your records. This link will also be sent to you automatically 3 days before your appointment. (You do not need to fill them out twice)

FILL OUT FORMS ONLINE CLICK HERE

 

OPTION 2: Downloadable forms. Please print them out, fill them out, sign necessary pages, and bring them with you to your appointment. You may attach your medication list to the forms instead of filling it in.

• HIPAA Privacy Practices [PDF]
• Patient Registration/History Form[PDF]
• Annual Office Policies [PDF]
• Previous Records Request[PDF]
• For parents/guardians of patients under the age of 18: Unattended Minor Patient Form [PDF]

 

 

Some patient reviews over the past 3 years