Get Personal Information - Concourse Optometry

Completing the Personal Information - Concourse Optometry form online is a straightforward process aimed at gathering essential details for your eye care. This guide will walk you through each section, ensuring you provide the necessary information accurately.

Follow the steps to complete the form efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by filling out your last name in the designated field. Ensure that the spelling is correct to avoid any discrepancies in your records.
3. Next, enter your first name as it appears on your identification documents.
4. Provide your date of birth in the specified format, followed by your age. This information is crucial for your appointment.
5. Fill in your Social Security number accurately, as it may be necessary for insurance verification purposes.
6. Enter your complete address, including street, city, state, and zip code. This will help in case follow-up correspondence is needed.
7. Add your email address, which will be used for appointment confirmations and communications.
8. List your home, work, and cell phone numbers in the specified fields, ensuring that the contact details are current.
9. Indicate your employer’s name and your occupation to assist with any necessary insurance paperwork.
10. Select your marital status from the options provided.
11. In the hobbies/activities section, briefly list any interests that require special visual needs, which helps optimize your eye care.
12. For the vision insurance information, circle the appropriate vision care plan that you are enrolled in from the options listed.
13. If someone else holds the vision policy, provide their name, social security number or ID, date of birth, sex, and your relationship to them.
14. In the medical information section, indicate your health insurance provider by circling the correct option and providing the necessary details of your policy.
15. Confirm how you were referred to the office by circling one of the methods provided.
16. Lastly, review services you may be interested in by circling your choices, ensuring that your needs are adequately reflected.
17. Once all fields are filled out, save your changes and download, print, or share the form as needed.

Complete your documents online to ensure a smooth experience at Concourse Optometry.