Online Forms

At Custom Eyes Optique & Eyecare, we value your time. In an effort to save you time in our office, you can complete the  New Patient Forms prior to arriving at our office.  There are two options below for completing your New Patient Forms.

The easiest and quickest way is to complete them online.  This avoids the need to print and bring with you.  Simply click on each of the links below in the Online Submission category, complete the form, and it will be sent directly to us.  

Online Submission:


If you prefer to not submit your forms online, you have the option of downloading the forms, fill them out at home, and then bring with you to your appointment.  Follow the instructions below for downloading:

  • You will need AdobeReader® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.

New Patient Health History Form – Required

Download & Print Form

Insurance and Payment Form – Required

Insurance and Payment Form


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Hours of Operation

Our Regular Schedule

Custom Eyes Optique & Eyecare


9:30 am-5:00 pm


9:30 am-4:00 pm


9:30 am-5:00 pm


9:30 am-5:00 pm


9:30 am-3:00 pm






Reviews From Our Satisfied Patients

  • "Went in with my daughter for the first time and it was amazing. I had an appointment that Monday and she squeezed me in right after."
    Christina E.
  • "Great doctor who really cares! Customer service is tops! Great selection!"
    Dan L.