• Welcome to Eyes on High

    Please take the time to fill out this registration card completely, this will ensure you receive the professional care and service that you deserve.
  • Personal Information HIPPA compliant submission

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  • Vision Care Benefit / Medical Insurance Information

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  • Below you can help us by including your MEDICAL ID card images, so we don't have to scan them in office (helping avoid unnecessary contact/contamination).  Even if you plan to use your Vision Care Benefit (VSP or EYEMED), it helps us to coordinate your benefits better with knowledge of your MEDICAL (Anthem, Aetna, Cigna, Medicare, Medicaid) insurance carrier.  

    Note: You do NOT need to upload your Vision Care Benefit IDs (Eyemed/VSP)

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  • Patient Eye Health History

  • Personal medical history

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  • Family Health History

  • Family Ocular History

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