C.R. LAIT OPTICAL
 
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patient forms
Check list to bring with you to your appointment:
  • Completed/Updated Medical History Form
  • Completed/Updated Lifestyle History Form
  • Signed Acknowledgment of Privacy Policy
  • Signed Insurance Billing Policy (if applicable)
  • Signed Medicare Policy
    (only if you have Medicare insurance)

  • Vision Insurance Card
  • Medical Insurance Card (needed on file in case of medical diagnosis)
  • Driver's License or other form of picture ID (needed for insurance, check or credit/debit card payment)
  • Any/All pairs of spectacles currently being worn
  • If available, written contact lens information (must have valid written Rx or original packaging)
Medical History Form
Lifestyle History Form
Medicare Policy Form
Notice of Privacy Policy
Insurance Billing Policy




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