Doctors of Optometry
17 Village Square, Chelmsford MA 01824 | 978-250-EYES (3937)

Registration Forms

When you arrive at our office for your first appointment, we will be asking you to complete some paperwork regarding your history and insurance information. If you would like to save time, please print out the forms below (given as PDF's) before the appointment and fill them out, being as accurate as possible. Then, please bring these forms with you to your first visit.

We have also attached a copy of the HIPAA PRIVACY ACT if you would like to review it.

History form (PDF)

Insurance Information & HIPAA Acknowledgement (PDF)

Notice of Privacy Practices (PDF)