Online Forms

At Fontana Eyecare Associates, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

New Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

Download & Print Form The Patient WELCOME Form is the initial form that we need filled out for all of our patients.

Download & Print Form

The Assignment of Benefits Form (above link) is mandatory for any patient that will be using any type of insurance, but also has an area for prescription information, so we do require it for every patient as well.

This form can also be printed, so please bring it with you as well!


Download the Free AdobeReader®

Contact Us

We look forward to hearing from you.

Location

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Hours of Operation

Our Regular Schedule

Office Hours

Monday:

9:00 am-5:00 pm

Tuesday:

9:00 am-5:00 pm

Wednesday:

2:00 pm-7:00 pm

We are Closed every other Wednesday

Thursday:

9:00 am-5:00 pm

Friday:

9:00 am-5:00 pm

Saturday:

9:00 am-12:00 pm

Sunday:

Closed