Amerine Eye Care
Preserving Sight for Life

Online Patient Forms

Online Forms

Appointment Checklist

Be prepared and bring the following to your appointment:
  • Comprehensive Health History Form
  • Complete list of medications (must include dosage, frequency and administration route)
  • Complete list of major surgeries (including date and type)
  • Valid state ID or driver's license and Insurance card(s) (referral if necessary)
  • Current glasses/contacts (or a picture of your contact lens boxes)
  • Bottle(s) of prescribed eye medications
Download Health History Form Download Authorization of Release Form
The forms are ready to be printed. Bring them completed to your first appointment.

Please use adobe or another
PDF viewer to electronically complete your form.
Download adobe here.

Medical Insurance Accepted

Our optometric physicians are licensed to treat and diagnose eye health diseases such as dry eyes, cataracts, glaucoma, diabetes, and many other eye health concerns. These medical conditions are billable under most major medical policies. 
Click here to see the list of Medical Insurance Accepted

Vision Insurance Accepted

 If you don't have eye health concerns and need a routine eye exam, it can be billed under your vision insurance.
Click here to see the list of Vision Insurance Accepted
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