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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.

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The health and well being of our patients, teams and communities is our highest priority. Our practices are temporarily closed for scheduled patient care March 19th through April 3rd. Please visit myeyedr.com for additional updates.