Get All Eyecare Optometry Intake Form

Completing the All EyeCare Optometry Intake Form online is a straightforward process designed to gather essential information about your vision and medical history. This guide will help you navigate through each section of the form to ensure all necessary details are accurately captured.

Follow the steps to efficiently complete your intake form.

1. Click ‘Get Form’ button to access the All EyeCare Optometry Intake Form and display it in your digital editor.
2. Begin filling out your personal information starting with your last name, first name, and middle initial. Further provide your complete address, contact number, and email address for communication.
3. Next, indicate your date of birth, age, and select your sex by marking 'M' for male or 'F' for female. This information helps in identifying your medical records accurately.
4. Specify the purpose of your visit in the designated section to assist the office in understanding your needs.
5. Fill out the sections for vision insurance and medical insurance. Circle the vision insurance provider if applicable and provide the medical insurance details, including member and group IDs.
6. Complete the medical history section by indicating any past diagnoses or treatments for specified health problems. Utilize 'y' for yes, 'n' for no, and 'f' for family history.
7. List any current medications and document any known allergies you have in the appropriate fields.
8. Detail your ocular history by indicating the date of your last eye exam and any previous eye conditions or treatments you have undergone.
9. Provide family ocular history by stating any relevant conditions that may run in your family, marking 'y' or 'n' as applicable.
10. Assess your visual needs by filling in information related to your daily screen time, hobbies, and any strain or discomfort you experience.
11. Review the section about understanding your vision benefits, ensuring you grasp the distinction between medical and vision insurance coverage.
12. Read through the Notice of Privacy Practices and acknowledge your understanding by signing and dating the provided space.
13. Finally, submit your completed intake form online. You may have options to save your changes, download a copy for your records, print it, or share it with the office.

Complete your All EyeCare Optometry Intake Form online today for a smooth and efficient experience!