Main Street Optometry - Vision Source

Dexter and Pinckney offices - New Patient Forms

The following forms are available online for your convenience, simply click on the form name to view the form. They are available in adobe .pdf format. If you don't have the Adobe Reader software, please click here or on the icon below the forms in order to install the reader software on your home computer. Please fill out all printable forms and bring them to the office with you.

New Patient Forms

 

New Patient Information - page 1

New Patient Information - page 2

HIPAA Disclosure / Billing & Financial Policy

Read/Print Main Street Optometry's HIPAA - Notice of Privacy Practices