Dr Kirschner's letter (click to read)
Please read. There is no need to bring this letter to your visit unless you have further questions for Dr Kirschner.

Thank you.

Patient History/Demographics (click to view form)
Please fill out these two pages in their entirety. The doctors reference these pages during your examination and they would like to have everything as accurate as possible. Thank you.

Refraction (click to view form)
Please sign this form if you are or are not having a refraction during your visit.It is stored for future use should you choose to have your vision checked for a new or updated prescription for glasses.

Financial Policy (click to view form)
Please print and sign.

HIPPA (click to view form or click to read Notice of Privacy Practices)
Please print and sign the HIPPA form. We will give you an official copy of the HIPPA guidelines when you come into the office. Should you not receive your copy, please ask the Front Desk receptionist for a copy.

Thank you

These PDFs require a free plugin that may have come included with your browser. If you are having difficulties opening these files Click Here to go to Adobe's web site for Adobe's PDF reader.