Patient Forms
| A little out of the way . . . A lot out of the ordinary! 1680 Calle de Alvarez, Suite D Las Cruces, NM 88005 ph: (575) 526-5367 fax: (575) 526-5057 |
| Invest in your vision. We do. |
Things to Remember and Help you Prepare for your Appointment:
- A parent or guardian must accompany children under the age of 18 in order to
complete and sign the necessary paperwork. Children under the age of 18 will NOT
be seen without parent/guardian signature on necessary paperwork
- Arrive 10-15 minutes early to allow time for the check-in process.
- Bring the following items with you:
- Photo Identification (FTC Red Flag law)
- Insurance Card (medical and vision, if applicable)
- List of medications and supplements including dosage and frequency
- Any relevant medical records for existing conditions related to eye care
- Doctor Referral Form –(If applicable): Mandatory for all children that have
not had their third birthday - Contact Lens wearers: please bring your most recent prescription and / or
contact lens box
- Please bring a driver, as you will most likely be dilated and your vision may be
adversely affected.
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |