Patient Forms Make an Appointment Contact Us
Elmquist Eye Group
    • About Us
    • Meet Our Doctors
    • Office Locations & Hours
    • Your First Visit
    • Make an Appointment
    • Hospital Affiliations
    • Testimonials
    • News
    • Eye Care Services
    • Comprehensive Eye Exams
    • Contact Lens Fittings
    • Diabetic Eye Exams
    • Cataract Evaluations
    • Refractive Cataract Surgery
    • Glaucoma Evaluation & Treatment
    • Dry Eye Treatment
    • Macular Degeneration Evaluation
    • Emergency Care
    • Full Service Optical
    • Astigmatism Treatment
    • Visioffice
    • Optical Boutique
    • Full Service Optical
    • Lens Choices
    • Lens Materials
    • Lens Options
    • Patient Education
    • Dry Eye
    • Glaucoma
    • Macular Degeneration
    • Cataracts
    • Diabetic Retinopathy
 

Your First Visit

To enable our Doctors and staff to best meet your particular eye care needs, we ask that you complete our registration and health history form. A list of your current medications and dosages as well as any previous eye care records will also be helpful.

Please remember to bring your glasses to each appointment. This information will help in diagnosing the most common conditions like myopia and astigmatism, as well as complex conditions such as glaucoma and macular degeneration.

Please print out and complete the registration and medical history form provided here in Adobe Acrobat format. Complete and sign the form and bring it with you when you visit us.

Adobe ReaderYou will need to download and install the free Adobe Acrobat reader to read this file. To download the Acrobat Reader click here.

 
» Registration & Medical History Form
 

About Us

About Us
Meet Our Doctors
Office Locations & Hours
Your First Visit
Make an Appointment
Hospital Affiliations
Testimonials
News
Testimonial Header
Testimonial Header
Thank you Elmquist Eye Group and staff, you are very kind and very considerate of your patients.
Sal J. Ragazzo
Fort Myers, FL
Testimonial Header
 
 
Copyright © 2011 - All Rights Reserved. Elmquist Eye Group.
Fort Myers Office: 12670 New Brittany Blvd., Suite 102, Fort Myers, Florida 33907  |  Tel: (239) 936-2020  |  Office Hours & Directions
Cape Coral Office: 2336 Surfside Blvd., Suite 121, Cape Coral, Florida 33991  |  Tel: (239) 936-2020  |  Office Hours & Directions
Shell Point Office: The Arbor Medical Clinic at Shell Point  |  Tel: (239) 936-2020  |  Office Hours & Directions
Home  |  About Us  |  Eye Care Services  |  Eye Examinations  |  Custom Cataract Implant Procedures  |  Designer Eyewear
Fort Myers Eye Care  |  Cape Coral Eye Care  |  Fort Myers Eyewear  |  Cape Coral Eyewear  |  Patient Eductaion  |  Patient Forms

isoosi web directory