Patient Forms

New Patient Forms

Welcome! If you’re planning your first visit to Wallingford Eye Care Center, we look forward to meeting you. To save time on your first visit, we encourage you to fill out our online forms or download and print them below.

If you do not already have AdobeReader® installed on your computer, Click Here to download.

New Patients 15 & Older

  • New Patient Forms
  • LINK
  • Medical History Form
  • LINK
  • Visual Lifestyle Questionnaire
  • LINK


​​​​​​​New Patients 14 & Younger


  • Pediatric New Patient Form
  • LINK
  • Pediatric Medical History
  • LINK
  • Visual Lifestyle Questionnaire
  • LINK


​​​​​​​Other


  • Contact Lens RX Release Form​​​​​​​
  • LINK
  • Record Release Form
  • LINK
  • Contact Lens & LASIK Patients
  • LINK


​​​​​​​Form Downloads


  • New Patient Form (Downloadable)
  • DOWNLOAD
  • Medical Release Form
  • DOWNLOAD​​​​​​​
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