a               a


Please print and complete these forms as directed. Bringing completed forms will shorten your time
at our office making your visit more convenient. You will need Adobe Reader software if you do
not already have it. If you have opened and read a .pdf file, you have it.
If you cannot open/read these forms, get the software here: Get Adobe Readera

If you are unclear on a particular item, skip over it and complete as much as
possible or call our office at 315-788-0022.

a Privacy Statement For your information and records, no need to bring.

a Adult Registration

a Minor Registration

a Medical_History_Questionnaire

a Medication_List

a Financial_Agreement

a Signature_on_File

 

© 2010 Jefferson Eye Surgeons, LLP. - Board Certified Ophthalmologists & Eye Surgeons - 315-788-0022 - Watertown NY