Patient Registration Forms

Please save time and help us be green by submitting your patient registration and history information through our secure online forms. If you prefer, you may download and print the patient forms to fill out at home and bring to your appointment.

Register online  or  Download Forms

New Patients

Please complete the online form at least 48 hours before your first office visit. This will save you time and make the office administration process easier.

Please come to your appointment with:

  • All glasses that you currently use
  • Your insurance cards and a photo ID
  • A list of any medications (including over-the-counter drugs), vitamins and supplements that you take

Contact Lens Wearers: Please come in wearing your contact lenses so their fit can be assessed. If you are experiencing significant discomfort, redness, discharge or abnormally blurred vision, do NOT wear your contacts but bring them to your appointment. New patients should bring a copy of your current contact lens Rx, your CL boxes or the prescribing doctor’s contact information. A refitting will be necessary if we cannot verify your prescription.

Previous Medical Records are generally not needed. However, if you have been treated or monitored for an ocular condition, bring contact information for your previous doctor.

Printable Forms: If you are visiting our office for the first time and would like to print out a paper copy of our Registration Forms, please use the links found below. Please fill out the forms and bring them with you to your scheduled appointment.

If you have any questions or need assistance, please call our office at 1-808-949-2662.

Registration Form fillable PDF

Medical History Form_ Fillable PDF

Y&I-Notice-of-Privacy-Practices

Current Patients

If you have moved or any of your patient information has changed please contact our office at 808.949.2662.

When you schedule your appointment, we will generate a pass code allowing you to verify and update your patient information and medical history. Please make any changes at least 48 hours prior to your appointment.

Register online

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