Patient Forms

Download patient forms

If you are a new patient, or if any of your personal information has changed since your last visit, please complete the forms below. You can fill out your patient forms in the office, or print and complete them before your visit.

If assistance is needed with accessing these forms or to request these documents in an alternative format, please contact the scheduling department for Bloomington at (812) 855-8436, option 1, or for Indianapolis at (317) 321-1470, option 1.

All patients

General Patient Information Form

Fill out your personal information, including home address, contact information, and insurance.

Email and Text Authorization

Let us know whether you would like to receive appointment reminders via text message or email.

Medical History Form

Tell us about your current medications, allergies, medical history, and family history.

Patients 12 years and younger

Pediatric Medical History Form

Detail your child’s medical and developmental history, as well as previous medical tests, evaluations, and vision care.

Consent to Treat Minor Patient

Authorize the IU School of Optometry to treat your child, and list the adults who may accompany your child at their appointment.

Our doctors are ready to see you.

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