PATIENT INFORMATION FORMS

At Urban Optiks Optometry, we value your time. In an effort to save you time in our office, we kindly ask that you complete your Patient Information Forms prior to your visit. We utilize a HIPAA (Health Insurance Portability and Accountability Act of 1996) compliant secure online patient portal for completing pre-examination paperwork.

We understand that you expect the highest level of security when it comes to the protection of your personal information. Our patient portal provider uses various authentication technologies and security controls which ensures your information remains private. The communication between the portal server and your computer is secured with digital certificates required by federal law.

Fill out the patient information form on your mobile device

If you are on your desktop or laptop and would prefer to complete them on your phone or tablet, simply scan the QR code below with your camera or QR reader.

New Patients
Returning Patients