Appointment Scheduling / Forms Download

Fill out the form below, and we'll contact you shortly afterward to confirm your appointment. If you prefer, appointments can also be made by calling (641) 422-EYES(3937). Online appointments must be scheduled at least 3 days from todays date.

NOTE: You must have flash installed on your computer. if you don't see the form below, click the yellow tab at the top of the page and select "allow blocked content" (trust us, this form is safe)

 

FORMS:

right click to download or print, left click to open in this window. Forms require Adobe Acrobat Reader, get it for free here.

 
Patient Information/Medical History Questionaire.pdf
 
Notice of Privacy Practices.pdf
 

 
 
   
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