If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site

WARNING

You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

Follow Us

At Twelve Bridges Vision Care, we value your time. In an effort to save you time in our office, you can complete our patient forms here and bring them with you to your appointment.


New Patient Registration Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals you have regarding your eye health or vision on the form.


HIPPA - Notice of Privacy Practices

If you would like to understand our privacy policies, we have included a copy of our HIPPA Notice of Privacy Practices for your review.


Contact Lens Fitting Agreement/Disclosure Form

Contact Lens Exam Fees Explained 

If you are interested in contact lenses, please read these forms.


Consent to Share Health Information

If you would like consent to disclose your health information with another party (eg. a family member), please print and complete the Consent to Share Health Information form.


Download the Free AdobeReader®