Pediatric New Patient Form

If you prefer, you may download this form and fill it out. Otherwise, use the form below.

To Our New Patient:

Our primary concern is providing you with excellent eye care. Your understanding of our policies and your cooperation with our procedures enables us to provide this care.

Complete eye exams take 1-2 hours and require dilation of the pupils. More complex exams will take longer and we ask you plan the day of your appointment accordingly. Dilation of the pupils usually wears off within 2-3 hours and may make driving difficult. Please arrange for someone to bring you if you feel it is necessary.

An explanation of our financial policy is included in the new patient forms. If you have any questions please contact one of our Patient Account Representatives at 404-351-2220.

Please Bring the Following With You to Your Appointment:

• Current insurance cards and I.D.
• List of all current medications and pharmacy information.
• Any referral forms required.
• All new patient forms completed.
• Notice of Privacy Practices Acknowledgement.