Skip to main content
Open Menu
Menu
eyeglasses-wall-display-on-a-slant-1280x480
Home » Contact Us » Online Patient Registration Form

Online Patient Registration Form

lock icon Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office. This form contains confidential information and is delivered to your doctor through a secure Internet connection. In addition, please Click Here to print out our additional form and bring it to your appointment.

x

As uncertain as you may be in this time with the COVID -19 Virus, we share in your concern. We are concerned about the safety of you and your families as well as our staff here at Professional Family Eyecare.

As of Tuesday, March 17, the CDC recommended the postponing of all routine eyecare at this time. Our Coldwater and Greenville office will remain open for EMERGENCIES BY APPPOINTMENT ONLY.

Contacts and Eyewear is available for curbside pickup ONLY BY APPOINTMENT ONLY.

Our St Marys office is temporarily closed.

Our Doctors and staff will be available via phone at the Coldwater and Greenville offices Monday- Friday 9:00am-2:00pm.

We will be carefully monitoring the situation and will keep you posted with any updates. We apologize for any inconvenience this may cause.