• 114 N State St, Westerville OH 43081          614-882-0851             info@uptowneyedoc.com

  • Please print and fill out the forms that apply to your visit.  If you are unable to do this, please arrive 20 minutes prior to your scheduled appointment so that we may get this completed.  

    Be sure to bring the following with you to your appointment:

    • Your insurance cards (vision and medical)
    • A list of your medications, including dosages
    • Any glasses that you currently wear, including over the counter reading glasses
    • Any contact lenses that you currently wear, including the boxes or copy of your current prescription
    • Payment/copays for your exam


    All Patients: 

    Patient Information and Medical Form

    Financial Information and HIPAA 

    HIPAA Policy to view: No signature required. Print for your records if desired. 

    Contact Lens Patients: 

    Contact Lens Evaluation Policy

    What to Expect At Your Exam