Patient Forms

Dr. Roger Weikum - Therapeutic Optometrist patient formsWe would like to know as much as possible about all of our patients so we can provide thorough and informed medical care to best treat the needs of our patients. Therefore, we ask all of our new patients to fill out a few forms before seeing the doctor for the first time. They will tell us about you, your insurance information, your medical and family health history and the purpose of your visit. With this information we can best serve your eye care needs. We have made these forms available here for your convenience so you might prepare them in advance. Just click on the link to download these PDF files and print them at home.

When you come for your appointment, please bring in the forms or we'll provide you with forms and you can still fill them in before your appointment.  Please don't forget to bring in your proof of insurance.

Please click here to download the pdf-icon Patient Forms.

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