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Home » Contact Us | Eye Doctors in Colorado Springs » 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.

Most medical health insurance plans do not cover Routine Vision and or dental plans. Vision Plans are typically considered supplemental coverage and typically have a specific ID# or use your SSN. It is the member's responsibility to know their insurance coverage and to provide information at the time of appointment.

Appointment cancellations need to be made 24 hrs in advance to your scheduled visit to avoid cancellation fees.

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🦃 Holiday Closure Notice 🎅
We’ll be closed for the holiday season on the following dates:
Nov 20: 8am – 5pm
Nov 21: 9am – 5pm
Nov 22: 9am – 2pm (closing early)
Nov 23-26: CLOSED
Nov 25: CLOSED
Nov 26: CLOSED
Dec 25-26: CLOSED
Warm wishes for a joyful holiday season and a brilliant New Year!