Patient Paperwork

We look forward to seeing you at your appointment!  Get the most out of your visit by completing your paperwork online in advance.

As we all move forward dealing with COVID-19 and the Corona virus, our office is taking necessary steps to keep our patients and our staff safe and healthy.

We have always wiped down all instruments between patients and will continue to do so moving forward.

Our office has also started wiping down all countertops and common areas at least every hour during the day.

We have also removed the magazines and toys from our waiting room to decrease potential for virus transmission.

Out of an abundance of caution, we will also be verbally screening all patients when scheduling appointments or entering the office.

Please come alone to your appointment. If someone must accompany you, please limit it to one person. Avoid bringing children.

Please inform the staff if you have:

  • Any flu like symptoms (fever, cough, sore throat, etc)
  • Been out of the country or anywhere with a travel advisory in the past 21 days
  • Been in contact with anyone who has tested positive for Coronavirus in the past 21 days

Routine Vs Medical Eye Exams **

In an effort to assist our patients in navigating the ever complicated realm of insurance, we have created a document explaining the difference between Routine and Medical Eye Exams.

** Please review the following PDF prior to your Annual Eye Exam. You may print it out, sign it, and bring it to your exam, or sign a copy in the office when you arrive for your appointment.


Submit Paperwork Online – HIPAA Compliant

For New Patients, you can submit your paperwork online here

For Established Patients, you can submit your paperwork online here


PDF Files

If you don’t want to submit your paperwork online, you can print and fill out the following forms and bring them with you to your appointment.

New Patients (PDF Files)

Established Patients (PDF Files)

Pediatric Patients (PDF Files)


Records Release

If you are transferring care either to or from Chapel Hill Eyecare, feel free to use our records release form.

Some other things to consider before you come in for your eye examination:

  • Dilation is an important part of a complete and comprehensive exam. It is highly recommended by both of our doctors and since it leaves near vision blurry for a few hours, you might bring a driver, or arrange for a ride if you are uncomfortable driving with dilated eyes.

Please make sure you bring:

– Glasses, Medication list, vision and medical insurance cards, and contact lens information if applicable