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Prescott
928-445-1341

Prescott Valley
928-775-4066

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Patient Forms

Looking for an optical shop with affordable glasses lens? Need eye disease detection and treatment? Call us in Prescott AZ at 928-445-1341 or in Prescott Valley AZ at 928-775-4066.

We have provided some of our patient forms below. Patients should complete/print these prior to their appointment and take them to their appointment.

VSP Consent Form

Our VSP Consent form is for our new patients. The form allows us to gather the information we need about the individual to better treat them.

Patient Consent/HIPPA Form

All new patients will need to fill out the patient consent/HIPPA form which helps you to understand how we handle your personal information.

Financial Policy Form

Patients will need to fill out this form to show us that you understand and agree with our financial policy.

Privacy Policy Form

Patients will need to fill out this form to show us that you understand and agree with our privacy policy.

Insurance Authorization Policy Form

Patients will need to fill out this form to show us that you understand and agree with our insurance authorization policy.

Qualified Staff
You get the best care because our doctors are the best!

Best Equipment
We invest in all the newest equipment to best serve you.

Two Locations
We offer two convenient locations to serve you better.

Emergency Service
We provide 24-hour emergency care every day of the year.

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Have Questions? We are Here!! DON'T HESITATE TO CONTACT US ANY TIME.