Fireside Eye Care Online Forms

At Fireside Eye Care, we offer patient forms online so you can complete them in the convenience of your own home or office. Fax or email us your completed forms or bring them with you to your visit.
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  • If you do not already have AdobeReader® installed on your computer, Click Here to download it now.

  • Download the necessary form(s) and fill in the required information.

  • Fax or email us your completed form(s) or bring them with you to your appointment.

Welcome form
Download
Medical History Questionnaire
Download
Authorization for Release of Health Information
Download
Notice of Privacy Practices
Download
Vision Insurance Acknowledgement
Download
Payment Policy
Download
Appointment check-in Form
Download