If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site

WARNING

You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

Follow Us

Online Forms for Shreveport Eye Clinic

At Shreveport Eye Clinic, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

New Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

Download & Print Form


Visual Lifestyle Questionnaire – Required

Our mission at Shreveport Eye Clinic is to provide you with the highest quality, personalized eyecare available. In order to do so we need to learn about your individual needs and preferences. The more we can learn about how, where and when you use your eyes, the easier it will be for us to provide you with the best possible eyewear recommendations. The following questions are intended to help us help you.

Download & Print Form


Patient Release for Information Form – Required

In order to access or share your personal health records please complete this information release form.

Download & Print Form


Download the Free AdobeReader®