New Patient Information

Thank you for booking an appointment with Chandler Eye Center.  We appreciate having you as one of our patients.

 

Here you will find the paperwork for your first visit.

 

Please print out the following documents and have them filled out PRIOR to coming to your appointment.

 

The refraction Policy MUST be signed to signify that you understand our policy.

 

Make sure to bring your insurance card!

New Patient Paper Work

Patient Information
NP 1.jpg
JPG image [183.8 KB]
Refraction Policy
This MUST be signed
NP 2.jpg
JPG image [167.8 KB]
Patient Medical History
NP 3.jpg
JPG image [138.8 KB]
Patient Medical History
NP 4.jpg
JPG image [114.9 KB]
HIPPA Signature
NP 5.jpg
JPG image [69.6 KB]
HIPPA
HIPPA.html
HTML document [17.0 KB]