Appointments: (413) 782-5339
Forms
Forms for New Patients
If you are a new patient to our office, please download, print, review and/or sign the following documents from below:
- Notice of Privacy Practices PV
- Signature Pages_Privacy_Assignment of Benefits*
- Health Questionnaire*
- Commitment to Quality
Items with a * should be brought to your appointment.
Forms for Returning Patients
Has it been a year or more since we've seen you? Coming in for an annual eye exam: We know paperwork can be a drag! So we are trying to make it less of a hassle. Updated information allows us to provide you with the best possible exam and products, as well as ensure we are able to accurately bill your insurance. Please take a moment to familiarize yourself with our "Documents" section below. Filling out the following forms in advance and bringing them with you, will help make your exam experience go more smoothly:
- Notice of Privacy Practices PV
- Signature Pages_Privacy_Assignment of Benefits
- Health Questionnaire
Glasses and Contact Lens Wearers
If you wear glasses and are thinking about purchasing your glasses from us or another location, see our "Commitment to Quality" document for helpful information on our policies.
Do you wear contact lenses? If you wear contact lenses and are considering purchasing them from us or another provider, please review our "Contact Lens Policy" below.
Are you a new contact lens wearer, or maybe a long time wearer who needs a little refresher? We've included some helpful documents below.