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patient  forms

Patient Forms

Please fill out the following patient information forms and bring them with you to your first visit. Signing "Acknowledgment of Receipt of Privacy Practices" on the form signifies that you have read the Privacy Policy, listed below.

  • Patient Information Form
  • Privacy Policy​
[NOTE: This PDF requires a free plugin that may have come included with your browser. If you are having difficulties opening this file Click Here to go to Adobe's web site for Acrobat Reader.]
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Location Info
8001 South Orange Blossom Trail , Suite 552
Orlando, FL 32809

Phone: 407-854-6969
Fax: 407-859-0699

Office Hours
Monday - Saturday:  10:00am - 9:00pm
Sunday:12:00pm - 8:00pm
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Notice of Privacy Practices.
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  • Home
  • Our Team
  • Services
    • Patient Forms
    • Eyecare Articles
  • Designer Frames
  • Schedule Appointment
  • Location