1802 Paper Mill Road, Wyomissing, PA 19610


PATIENT FORMS


We are very pleased you have chosen Berks Eye Physicians & Surgeons to care for your eyes. It is our privilege to provide excellent medical care in a pleasant, friendly, patient-centered environment. Our practice offers a broad scope of medical and surgical eye services including state-of-the-art cataract surgery, laser vision correction (LASIK), and glaucoma management. We provide comprehensive family vision care, contact lens examinations, and dispense glasses and contact lenses. Emergency eye care is available 24 hours a day. Berks Eye has extremely qualified physicians and surgeons, certified technicians and opticians, and a caring support staff ready to assist you.

Please bring the following to your appointment:

  • Completed new patient forms
  • Current medical and vision insurance cards
  • Insurance referrals if required
  • Photo identification
  • List of medications that you use, their dosage, and frequency
  • Method of payment for copays and other charges due on the day of service (we accept cash, checks, VISA, Mastercard, Discover, and American Express)

Your initial examination will take between 1-3 hours depending on the complexity of your examination. As a standard part of your visit, our technician may use drops that will enlarge your pupils. These “dilating” drops will cause light sensitivity and some blurring for several hours. We recommend having a driver for your trip home. Patients less than 18 years old must be accompanied by a parent or legal guardian.

If you are a current contact lens wearer, if possible, please bring a copy of your prescription or your boxes/vials with you to your appointment. Please also bring any back-up eyeglasses you may wear on occasion.

Please call us at (610) 372-0712 if you have any questions. Thank you for allowing us to participate in your eye care. We look forward to meeting you!

Please click on one of the links below to download the corresponding form:

NEW PATIENT REGISTRATION FORM (.PDF)
(.PDF files can be downloaded, printed, filled out and brought to your appointment.)

(EDITABLE) NEW PATIENT REGISTRATION FORMS (.DOC)
(.DOC files can be edited, printed and brought to your appointment.)

MEDICAL RECORDS RELEASE

MINOR MEDICAL CONSENT FORM

LASIK CONSULTATION REGISTRATION PAPERWORK

Font Size:  
MENU