801-302-3080

New Patient Forms

Forms and What To Bring To Your Appointment

As a new patient to our practice, we would like to offer a warm welcome and our thanks for choosing us to provide your eye health and vision care. In order for us to establish your file, and provide the most beneficial use of your time with us, the doctor has asked you to complete the following tasks and bring the results to your appointment. We look forward to your visit!

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Completed Welcome to the Office Form:

This diagnostic information includes personal and family information needed to establish your file, as well as your current eye health and vision status. Please provide all of your insurance information so we may assist you with your coverage.

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Completed Medical and Eye Health History:

Since many general health conditions may be associated with visual symptoms this important record will allow us to care for you as a “whole person” rather than just a pair of eyes. This form includes a complete list of prescription and non-prescription medication, which may be brought in as a separate list for us to photocopy if you prefer. Your responses will guide our doctors and staff, and remind us to address any significant issues during your visit.

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Eyeglasses:

Please bring ALL pairs of eyeglasses you currently use, including prescription or non-prescription reading glasses, sunglasses, etc. We have instruments to compare the optical power of your old lenses with your new exam findings, thus enabling us to determine and explain how your vision has changed over time. We can also evaluate the condition and fit of your current eyewear.

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Contact Lenses:

It is best to wear your current contacts to your appointment if possible. Next best is to bring them along in your case. If you wear planned replacement or disposable lenses, it is very helpful if you bring along your cartons or lens packets that indicate the lens series, power, manufacture, etc.

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Eye drops, ointments, etc:

Please place any eye drops or ointments that you use in a small bag and bring it along with you. Your doctor will review whether these or appropriate or if a better option is available.

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Dilation Explained:

The doctor may need to use drops to dilate your eyes in order to fully evaluate their internal health. This has the effect of temporarily increasing sensitivity to light and causing “fuzzy” vision at a near (reading) distance. Therefore, if you want new eyewear or feel you may need to select new eyewear, please come 15 to 20 minutes before your appointment time in order to look at our frame selection.

We'd Like to Meet You!

Come and experience the exceptional quality of service that is characteristic of Family Focused Eye Care.

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Contact
5532 West Herriman Main Street Suite #120
Herriman, UT 84096

info@visionbeyond2020.com
801-302-3080

Office Hours
Monday- Thursday: 9:00 AM – 6:00 PM
Friday: 7:00 AM – 2:00 PM

Closed Saturday & Sunday

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