Patient Forms

Thank you for choosing Plainfield Vision Care. We would like to take this opportunity to welcome you as a patient.

In order to help setup your chart and decrease your waiting time to be seen by the doctor, please print and complete the forms listed below.  If you are having difficulties viewing these PDF documents, you may need to download and install the free Adobe Reader software.

Please bring the following forms (click on the links below) and information:

Receipt of Notice of Privacy Policies of consent Form

Contact Lens Check List

We participate with and array of insurance carriers. If you have any questions regarding your health or vision insurance coverage, please contact your insurance company or our office prior to your visit.

Thank you for entrusting our practice with all of your vision needs. We look forward to taking care of you and your family. Please feel free to contact the office with any questions you may have.