Office Forms

Using the links on this website, you can fill out our health intake and office authorization.

Click here to fill out the new patient health intake form and submit it to our office.

Click here to fill out the new patient health intake form and submit it to our office.

Click here to fill out the established patient health intake form and submit it to our office.

Click here to fill out the established patient health intake form and submit it to our office.

ESTABLISHED Patient health intake

Welcome back to Mineola Eyecare. Please ask if you need help. Upon request, we can provide you with a paper copy.

New Patient health intake

Welcome to Mineola Eyecare. This form replaces the traditional paper health intake forms. Please ask if you need help. Upon request, we can provide you with a paper copy.

Click here to take the assessment and submit it to our office.

Click here to take the assessment and submit it to our office.

AMD Risk Assessment

Age-Related Macular Degeneration (AMD) is the leading cause of blindness in adults. Its effects are permanent and irreversible, and only in some cases is it effectively treated. When detected early, AMD is best managed through life style changes, improved nutrition, and careful monitoring by your eye doctor.

If you have VSP insurance, click here to fill out the questionnaire and submit to our office.

If you have VSP insurance, click here to fill out the questionnaire and submit to our office.

VSP Patient History Questionnaire

The questionnaire is to be reviewed at each appointment.