A Family Medical and Surgical Eye Practice Devoted to Occular Health 
Your Vision is Our Focus

NEW PATIENT

REGISTRATION FORMS


This link provides NEW PATIENTS the opportunity to expedite their patient registration forms prior to their scheduled appointment.    There are 4 registration forms.   

 

1. Patient/Medical History/Insurance Document

2. Crossroads Patient Policy Document

3. Privacy Act Document

4. Contact Lens Policy & Agreement

 

All 4 documents may be printed and mailed to us by clicking on the files below.  Simply click and print the documents, fill them out accordingly, and mail them to us at least 3 days prior to your scheduled appointment. 

 

 

 

To Use Our On-line Submittal Forms:

 

Click on the drop down bar found  under this navigational link if you prefer to submit the  Patient/Medical History Form and Patient Policy Document  via online.


The Privacy Act Document and Contact Lens Policy & Agreement forms can only be printed and mailed to us, or you can fill them out and bring them with you at the time of your appointment.  You'll also find access to print the Patient/Medical History Form and the  Patient Policy Document below. All 4 forms can also be completed at the time of your scheduled appointment. However, completing the available 2 forms via this website is recommended to expedite your visit. Thank you!

Printable Versions of Necessary Documents Below