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Online Forms

At Lakepointe Vision Center, 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 AdobeReaderĀ® 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 (618-624-3940) or bring them with you to your appointment.

NEW PATIENTS

Welcome Form (To be Completed)

Patient Medical Record Release (To be Completed)

Policy Signature Sheet (To be Completed)

Office and Contact Lens Policies (Patient Copy)

Financial Agreement (Patient Copy)

Notice of Privacy Practices (Patient Copy)

ESTABLISHED PATIENTS

Welcome Form

Office and Contact Lens Policies

Patient Medical Record Release

Financial Agreement


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Contact Us

We look forward to hearing from you.

Location

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Hours of Operation

Our Regular Schedule

Monday:

8:30 am-5:00 pm

Tuesday:

12:00 pm-7:30 pm

Wednesday:

8:30 am-5:00 pm

Thursday:

8:30 am-5:00 pm

Friday:

8:30 am-5:00 pm

Saturday:

Closed

Sunday:

Closed