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Your comprehensive eye exam at Miamisburg Vision Care will include a thorough evaluation of your visual needs and your ocular health.

The examination will include measurement of your visual acuity, depth perception, eye coordination, eye pressures and overall eye health. In order to fully evaluate your ocular health, our doctors recommend Optomap retina photos. In many cases Optomap photos can replace the need for dilation of the pupils. The visit usually takes 30-40 minutes to complete, and allows for time to select new eyeglasses and/or contact lens evaluation. If you would like to fill out some of your paperwork prior to arriving, please click on appropriate link to print out and complete in advance. Feel free to complete and bring with you the Registration Form and any of the other forms that may be pertinent to your eye examination.

At Miamisburg Vision Care, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

New Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals you have regarding your eye health or vision on the form.

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ALL PATIENTS

Registration Form

Please bring with you for your appointment. Circle anything that applies to you, or your family (in the family section).

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Notice of Privacy Practices

Please take a moment before your exam to read and fully understand our privacy policy.

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HELPFUL QUESTIONNAIRES

Lifestyle Questionnaire

This questionnaire is designed to assist you and our staff in helping select the best lenses, frames and/or contact lenses to suit your visual needs and lifestyle. Take a few moments to answer the following questions or work with our staff to answer them together.

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Dry Eye Questionnaire

If you experience dry eyes, please fill out and bring with you to your appointment.

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Computer Vision Questionnaire

If you have trouble with your eyes while using a computer please fill out and bring with you to your appointment.

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SPECIALTY VISITS

Infant See

Please bring with you for child’s appointment. Circle anything that applies.

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Low Vision Eval

Bring with you for your low vision evaluation. Circle anything that applies.

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Low Vision Questionnaire

Please bring with you for your appointment. Circle anything that applies.

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