Eyecare Eyewear Center
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Download  and  Print  Our  Patient  Forms

Patient Forms

If you are a new patient to our office, please print the Medical History/ Welcome form, fill it out as best you can and bring it with you to your appointment.
Medical History/Welcome form
File Size: 103 kb
File Type: pdf
Download File

If you are a new patient to our office, it's very helpful to know your ocular history. Please print the medical release form, fill in the name/address/phone number of your previous eye doctor and sign the form. You can drop it off before your exam or bring it in at your appointment.
Medical Records Release Form
File Size: 471 kb
File Type: pdf
Download File

This form contains information for new soft contact lens wearers.
Soft Contact Lens Instructions
File Size: 54 kb
File Type: pdf
Download File

This form provides some helpful information about wearing and adapting to monovision contact lenses.
Monovision Wearing Instructions
File Size: 81 kb
File Type: pdf
Download File

EyeMed Vision claim form for reimbursement.
eyemedclaimform.pdf
File Size: 2562 kb
File Type: pdf
Download File

Contact Us
Eyecare Eyewear Center
1093 N Union St.
Middletown, PA 17057
Phone: 717-944-4031
Fax:  717-944-1890
[email protected]

Office Hours
Mon    9:00 am - 5:00 pm
Tue     9:00 am - 7:00 pm
Thu     9:00 am - 5:30 pm
Fri       9:00 am - 3:00 pm

*We are not open every Saturday* We generally are here one Saturday a month from 9-4.  Hours may vary, always check the location tab of our website.
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  • Home
  • Our Practice
  • Our Services
    • Re-Order Contacts
    • Links
  • Patient Forms
  • Promotions/What's New
  • Eye Care Articles
  • Location