New Patient Intake Forms
New and returning patients must complete the new patient paperwork (as applicable) prior to their visit. Children under 18 must have a parent or guardian sign each form.
Be sure to complete all forms and hit Submit. If you would prefer to fill out paper forms, please scroll to the bottom of this page.
Intake Forms (Ages 13+)
Intake Forms (Ages 13+)
Intake Forms (Ages 13+)
Complete these forms for patients ages 13 and up.
Pediatric Forms
Intake Forms (Ages 13+)
Intake Forms (Ages 13+)
Complete these forms for patients ages 13 and under.
Contact Lens & LASIK Patients
Contact Lens & LASIK Patients
Contact Lens & LASIK Patients
If you wear contacts, are interested in contacts, or have had LASIK surgery, please complete this form annually.
Insurance Form
Contact Lens & LASIK Patients
Contact Lens & LASIK Patients
If you are an existing patient and would like to update your insurance on file, please complete this form.
Printable Paperwork
If you prefer to fill out paper forms, you can download the PDF here and print them at home.
Don't forget to bring them with you when you come in!
AllForms2021 (pdf)
DownloadWallingford Eye Care Center
821 North Main Street Ext, Wallingford, Connecticut 06492, United States
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