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NEW PATIENT FORMS

We'd like to welcome you to our office! To best serve your visual and eye care needs, please download, complete, and print the Patient Information Form. You may email it back to us at info@bengoaeyecare.com, mail it to our office, or drop it off prior to your appointment. You may also bring it a few minutes prior to your appointment, though if you're scheduled for the first appointment of the day we do not open early. Please also review our "Notice of Privacy Practices". When you come for your appointment, please bring any vision and medical insurance cards, and all eyeglasses that you typically wear, including any non-prescription sunglasses and reading glasses. If you currently wear contact lenses, please arrive wearing your contacts and bring either your most recent contact lens Rx or packaging from the contacts showing the lens information. We look forward to being a part of your vision care for years to come!
 

Patient Info Form

 

Notice of Privacy Practices FormNotice of Privacy Practices

The forms on this page are in Adobe pdf format. If you are unable to view

them you may need to download the free Adobe Reader with the link below.

Get Adobe Reader

 

 

   
 
 
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