Download Patient Forms
Vision Care & Therapy Center
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.)
Adult Eye Exam Form
Child (Extended) Questionnaire
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