If you are a doctor refering a patient please click the button below and fill out the referral form
Thank you for choosing Frantz EyeCare. We appreciate your confidence in us.
There are several forms that you will need to complete for your first visit to our office. These may be submitted electronically or you may print out the forms and bring them with you. This will save you the time of having to complete them at the office.
Whether you complete the forms electronically or print them out, there are several other items that you will need to bring with you to your appointment:
- Your insurance cards
- Valid driver’s license or photo identification
- A list of all medications that you are presently taking including amount and dosage
- A pair of dark sunglasses as your eyes will be sensitive to light if dilated
- Your eyeglasses or contact lenses so that we may check your prescription
- Since your eyes will be dilated, please bring someone with you to drive you home as dilation causes temporary blurring and light sensitivity. You may expect your first visit to last approximately two hours.
You may also wish to review other information provided on this website prior to your visit.
We make every effort to provide you with affordable medical care and accept cash, personal checks, MasterCard, VISA, Discover and American Express. If you have any billing or insurance questions, please feel free to call our Insurance Department at (239) 418-0262.
If you choose to complete the forms and submit electronically, please click on the link below:
Once you’ve filled out our online registration, please print out your confirmation page and bring it with you to your appointment.
If you prefer to print out the forms and complete them at your convenience to bring with you to your first visit, please click on each PDF form below to download. Remember to bring them with you to your appointment. Adobe Acrobat is required to view and print the forms.
- Patient Registration Form
- Patient Medical History
- Patient Vision Lifestyle Questionnaire
- Lifetime Authorization
- Notice of Privacy Practices Acknowledgment
- Limited Patient Authorization
- Notice of Privacy Practices (For information only, not necessary to bring this form with you.)
We have full optical shops at all of our locations. If you plan to visit our Optical Shop please remember to bring your vision plan card. If you are unfamiliar with your plan benefits, please contact your insurance carrier to help expedite your selection and purchase on the day of your examination.
We want to do everything possible to make your first visit with us a special one. If there is anything that we can do to make your visit more pleasant, please do not hesitate to let us know. We look forward to seeing you.
The Staff of Frantz EyeCare