New Patients

New Patient Form

Welcome! If you’re planning your first visit to Custom Eyes, we look forward to meeting you. To save time on your first visit, we encourage you to print and fill out our new patient forms below.

If you do not already have AdobeReader® installed on your computer, Click Here to download.

• Download the necessary form(s), print it out and fill in the required information.

• Complete your forms and bring them in with you to your appointment
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Download and Print Form

• Patient Information
• Patient Authorization
• Patient Information History
• Medical History & Occular HIstory
• Privacy Notice