Woman with eyeglass

Make your visit fast and simple

Fill out these patient forms in advance of your first visit for your convenience



Vsp, Anthem, Cook, Eye Med, Siho Insurance Services, CareSource, & Blue View Vision

Stay ahead of schedule with online forms

Your life is busy. Simplify your day by filling out the forms you need to complete before your first visit.

It's easy - just print and fill out the forms, bring them with you to your appointment, and present them to our friendly front desk staff. Your appointment will go even faster and more smoothly!  Established patients are asked to update their paperwork every three years.

Brinegar Eye Care accepts and files many medical and vision plans including Aetna, Anthem, Anthem Blue Vision, Blue View Vision, Cigna Vision, Cook, Eyemed, First Health Network, Humana Vision, Medicare, SIHO, Sagamore, Tricare, VCP, and VSP.

Just fill out the forms below before your first appointment:

Note: Read carefully and complete forms in black ink.

Patient Form 1
Patient Form 2

Also, please review our Privacy Practices:

Privacy Practices

For an appointment with our expert and caring staff, call Brinegar Eye Care today.


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