New Patient Forms

At Children’s Clear Vision, we offer patient forms online so you can complete them in the convenience of your own home or office.

Pediatric Patients (18 years and younger)

Pediatric Patient Intake – (English) | (Spanish)
Pediatric Health History – (English) | (Spanish)
Consent for Dilation – (English) | (Spanish)
HIPPA/Financial Responsibility – (English)

Adult Patients (19 years and older)

Patient Intake – (English) | (Spanish)
Patient Health History – (English) | (Spanish)
Consent for Dilation – (English) | (Spanish)
HIPPA/Financial Responsibility – (English)

Release Forms

General Photo Release Form – (English)
Request For Release Of Medical Records – (English)

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don't wait to get quality care for your child.

Since children don't always know what "normal" vision is supposed to look like, they may not be aware of vision problems. Regular eye exams help ensure normal vision development, detect any learning-related vision problems, and catch early signs of eye disease. By scheduling your appointment today, you're helping to set your child up for a lifetime of good eye health.

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