Patient Forms

These forms/packets can be printed and brought into the office, or emailed to vpballard@gmail.com. Please note that we require signatures or initials be handwritten, and so we may have these records printed and ready for your next visit to the office to obtain those handwritten signatures or initials.

Welcome Packet

Patients can save time during their first appointment by completing the Welcome Packet.

HIPAA Right of Access form for Family/Friends

Patients will need to sign this form to allow family/friends to access their protected health information (PHI). Please note that children that turn 18 will need to fill out and sign one of these forms in order for their PHI to be able to be shared with their parents.

Request for Records from OUR office

Patients can use this form to request that Vision Plus send their records to another office.

Request for Records from another office

Patients can use this form to have Vision Plus request their records from another office via Fax.

Pre-Owned Frame Release Form

Patients will need to sign and date this form in order to submit their own frame to Vision Plus to have prescription lenses made. Please note that all patient pre-owned frame jobs are subject to Optician Approval, and regardless of approval, Vision Plus is not liable for any damages done to frames during the insertion and removal of lenses, frame adjustment and alignment, or any other manipulations requested by the patient.