Patient Forms

Patient Intake Form

Patients coming to EyeCare Specialties of Ohio can prepare their paperwork before the appointment. Simply print out and complete the patient history form and bring it with you to your appointment along with your old eyewear, insurance card and photo I.D.

PATIENT INTAKE FORM- ENGLISH PATIENT INTAKE FORM- SPANISH

Care Credit Application

When to update and upgrade your eyeglasses should be the question, not how are you going to pay for it. To make that decision even easier for our patients, we offer the CareCredit ® card.  EyeCare Specialties of Ohio partners with CareCredit to provide financing options to our patients. CareCredit is a payment option specifically for healthcare needs. You can use CareCredit for exams, contact lenses, and even eyeglasses.  CareCredit lets you upgrade your eyeglasses or contact lenses and then pay for them over time with low monthly payments that fit easily into your monthly budget. Now you don’t have to save up to get the eyewear you’ve always wanted.  CareCredit offers low minimum monthly payments and no up-front costs or pre-payment penalties.  To apply online, click the button below.

Care Credit Application

Notice of Privacy Practices

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