Patient Forms

For your convenience, we have made a number of forms available for patients to download. If you are new to our practice, we encourage you to download and print out the new patient forms. Filling these out in advance of your first visit will minimize the time you spend in the waiting room filling them out when you get here. Other forms are informational. If your doctor has given you a form with specific information or instructions different from the information on these online forms, rely on the information given to you by your doctor, not on the online forms. If you're not sure which forms you need, please call 610-687-6888 for assistance.

If you're unable to open these files, you probably need to download the free Adobe Acrobat Reader program, which is available at the following location: www.adobe.com/products/acrobat/readstep.html

Click on the forms you would like to download:

New Patient Forms:

• Complete Package (individual forms below)
• Patient Registration Form
• Medical History Questionnaire
• HIPPA Patient Consent Form
• Exam Type and Fee FAQ
• Education and Training FAQ
• Contact Lens Agreement
• Our Ophthalmologists

Pre & Post Operative Instructions:

• Cataract Pre-Op
• Cataract Post-Op
• Plastic Surgery Post-Op

Patient Educational Downloads:

• Vision Problems in US - Full text of report
• Recommended Guidlines for Comprehensive Medical Examination of the Eyes

Consent Forms:

• General Consent Form
• Cataract / Intraocular Lens Consent
• Cataract / Multifocal Lens Consent
• Laser Trabeculoplasty Consent
• Laser Iridotomy Consent

Consultation / Referral Form (for Doctor's offices only):

• Consultation / Referral Form