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Patient Forms/What to Bring

Patient Forms:

Before your next visit to the Aboite Family Eyecare office please print and complete the following patient forms (to the right), as well as print Our Notice of Privacy Practices for your records.
Please bring the completed forms with you for your appointment. This will save you time when you get here and make for a more relaxed experience while here at our office.

  • Confidential Eye and Medical History Form
  • Acknowledgement of Receipt of HIPPA Privacy Practices Document
  • Office Financial Policy
  • Notice of HIPPA Privacy Practices Policy


What to bring with you:

To permit us to better serve you during your visit please bring the following:

  • Both medical and vision insurance cards
  • Current eyeglasses and/or contact lenses
  • Your completed patient forms
  • Wear your current contact lenses


Your visit may be an hour or more in length and your eyes may be dilated.
Most people drive themselves when they leave; however, if you feel less certain about driving afterward please bring a driver.

We look forward to seeing you soon.


Office hours & location
Monday - Friday 
8:30 am - 5:30 pm

7625 W. Jefferson Blvd.
Fort Wayne, IN 46804
(260) 432-1231


Call for an appointment!

Map

 




DOWNLOADS

  • Financial Policy
  • Medical History Side 1
  • Medical History Side 2
  • Ack. of Receipt of HIPPA
  • Patient Medicare Auth.
  • Notice of HIPPA

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