Patient Information
Download Patient Forms
Vision Care & Therapy Center
Patient Forms
Our Patient Forms are listed below. Simple Click on the Form required for your appointment ~ you will be directed to a PDF file of the form which you can download from your browser.
Once you’ve completed your form(s) please fax to 678-256-3995, prior to your appointment or bring it with you.
(If you don’t have the Adobe Reader App installed on your computer; please click here.)
Patient Form
Adult Eye Exam Form
Patient Form
Adult Questionnaire
Patient Form
Child Questionnaire
Patient Form
Child (Extended) Questionnaire
Patient Form
Rehab Questionnaire
Success Stories
What Our Patients Say
Before eye therapy, I was not comfortably reading out loud in the classroom. I was late with my assignments and was pulled out of my language arts. I was also three grade levels behind my class in reading. Reading was a chore for me. Now my grades have improved and I will raise my hand to read out loud in class. I have improved two levels in reading and I am beginning to enjoy reading. Soon I expect to be above grade level. Assignments are completed on time and I am working more independently with my homework. Look at my handwriting it’s the best now.
Gwynn | Patient
CONTACT US
Vision Care & Therapy Center
Dr. Janna Iyer, FCOVD
Dr. Alayna Larsen
11735 Pointe Place
Roswell, Ga 30076
678-256-3990
Office Hours
Mon-Thu 9:00am-6:00pm
Fri 9:00am-1:00pm
Appointments
678-256-3990
Patient Infomation