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Patient Forms

Click To Open or Download To Your Computer/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 Download button below.

To Download The Current Version of Adobe Reader To View and Print The New Patient Forms Click The Get Adobe Reader Download Button To The Right.

Download The Welcome To Our Office and Medical History New Patient Form Click On The New Patient Form To The Right.

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.