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New Patient Forms

We are thrilled to welcome you as a new patient to our practice. Your vision and eye health are of utmost importance to us, and we are dedicated to providing you with the highest quality eye care services.

To ensure that your visit with us is as smooth and efficient as possible, we kindly request that you complete the new patient forms before your appointment. These forms are essential for our team to better understand your medical history, current eye health, and any specific concerns you may have.

To access the new patient forms, simply click on the links provided below. You can download the forms to your computer, print them out, and fill them in at your convenience. Bringing the completed forms along with your ID, insurance card(s), and up to date medication list with you to your appointment to expedite the check-in process, allowing us to focus more on your eye care needs during your visit.

To edit the form we recommend this website.


Patient information form

Medical history form


Formulario de Información del Paciente

Formulario de Antecedentes Médicos

Tiếng Việt/Vietnamese

Biểu mẫu thông tin bệnh nhân

Biểu mẫu lịch sử bệnh lý

At Shiloh Eye Care, our experienced team is committed to providing compassionate, personalized care tailored to your individual needs. If you have any questions or need assistance with the forms, please don't hesitate to contact our friendly staff. We are here to help and ensure that your experience with us is exceptional from the moment you step into our practice.

We look forward to meeting you and providing you with the best possible eye care to keep your vision clear, healthy, and vibrant. Thank you for choosing Shiloh Eye Care, and we can't wait to see you soon!

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