Patient Forms

Patient Intake Form

Patients coming to Alvernon Optical can prepare their paperwork before their appointment. Simply print out and complete the patient history form and bring it with you to your appointment along with your old eyewear, insurance card and photo I.D.

PATIENT INTAKE FORM- ENGLISH PATIENT INTAKE FORM- SPANISH

Medical History Form

Records Release Form

Medical Suppliers Standards

Care Credit Application

Worrying about not losing your eyeglasses should be the question, not how are you going to pay for it. To make that decision even easier for our patients, we offer the CareCredit ® card. Alvernon Optical partners with CareCredit to provide financing options to our patients.  To apply online, click the button below.

Credit Care Application

Notice of Privacy Practices

HIPAA Notice