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Patient Forms

Access our patient forms that you can fill out before your next visit to VisualEyes of the Palm Beaches in Jupiter.

Online Patient forms


Please come to your appointment with:

  • Any glasses that you currently using
  • Your insurance cards ( both vision and medical) and a photo ID
  • A list of any medications (including over-the-counter drugs), vitamins and supplements that you take as well as any eye drops you are using.

For Our CL Wearers:

Please come in wearing your contact lenses so their fit can be assessed. Do NOT wear your contacts f you are experiencing any discomfort, redness, discharge or abnormally blurred vision, but bring them to your appointment.  New patients should bring a copy of your current contact lens Rx,and or your CL boxes.

Previous Medical Records:

These are not always  needed.  However, if you have been treated or monitored for an ocular condition,Or medical condition in which an eye exam was recommended please bring contact information for your doctor or any notes you may have.

Call our office at (561) 625-4380  if you have any questions. Thank you for choosing Us for your eye care needs. We look forward to seeing you soon!


Our Printable Forms