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Patient Forms

Click To Open or Download .PDF Forms To Your Device

For your convenience, we have made our patient forms available online so that you can fill them out in advance. When you come for your appointment, please bring the completed forms with you and give them to the receptionist as you check in. This will allow us to serve you more promptly. If you prefer, you may arrive for your appointment fifteen minutes early to complete the necessary paperwork.

Thank You for choosing Dr. Summerow as your eye care provider!

To print the patient forms, please click on the links below:

If you don’t have Adobe Reader on your computer you can download the latest version of Adobe Reader by clicking on the Get Adobe Reader button to download the a current version of Adobe Reader to view and print our patient forms. 

Download our Welcome To Our Office and New Patient Medical History form click on this form NOW!

Download the Pupillary Dilation Consent Form even if you are not sure whether this will be preformed during your visit so that you can be prepared prior to your visit.