Get New Patient Information Form - Welcome To Our Office - Niwot Vision

Completing the New Patient Information Form is an essential step in ensuring you receive quality care at Niwot Vision. This guide provides you with clear instructions on how to fill out the form online, ensuring that you provide all necessary information accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin filling in the date at the top of the form, using the format day/month/year.
3. Next, enter your full name, including your first name, middle initial (if applicable), and last name. Additionally, provide any nickname you prefer to be addressed by.
4. Fill in your address, including street, city, state, and zip code.
5. Provide your occupation and, if applicable, the name of your spouse.
6. Enter your home phone, work phone, and cell phone numbers to ensure you can be easily reached.
7. Include your email address for any correspondence or appointment reminders.
8. Specify your date of birth and age.
9. Indicate your sex using the provided options.
10. List the person who referred you, if applicable.
11. If you are not responsible for the bill or if you are a minor, fill in the details of the responsible party, including name and address.
12. Describe the nature of your appointment briefly.
13. Record the date of your last visual examination and the name of the doctor who conducted it.
14. Provide details about any prescriptions you were given, including current spectacles and contact lenses, if applicable.
15. Share any previous eye conditions, surgeries, or significant medical history related to your eyes.
16. List any current medications you are taking and mention your sports, hobbies, or interests.
17. Indicate any medical conditions you or your relatives may have, such as glaucoma or diabetes.
18. Review the office policy statements and confirm your understanding by providing your signature and the date.
19. After completing all the sections, save your changes, download a copy, and print if necessary. You may also choose to share the completed form as required.

Start filling out your New Patient Information Form online today for a smooth visit!