Online FormsYour comprehensive eye exam at Miamisburg Vision Care will include a thorough evaluation of your visual needs and your ocular health.

The examination will include measurement of your visual acuity, depth perception, eye coordination, eye pressures and overall eye health. In order to fully evaluate your ocular health, your eyes will likely be dilated. The visit usually takes 45-90 minutes to complete, and allows for time to select new eyeglasses and/or contact lens evaluation. If you would like to fill out some of your paperwork prior to arriving, please click on appropriate link to print out and complete in advance. Feel free to complete and bring with you the Registration Form and any of the other forms that may be pertinent to your eye examination.

All Patients

Registration Form
Please bring with you for your appointment. Circle anything that applies to you, or your family (in the family section). Registration Form

Notice of Privacy Practices
Please take a moment before your exam to read and fully understand our privacy policy. Download Notice of Privacy Practices

Helpful Questionnaires

Lifestyle Questionnaire
This questionnaire is designed to assist you and our staff in helping select the best lenses, frames and/or contact lenses to suit your visual needs and lifestyle. Take a few moments to answer the following questions or work with our staff to answer them together. Download Lifestyle Questionnaire

Dry Eye Questionnaire
If you experience dry eyes, please fill out and bring with you to your appointment. Download Dry Eye Questionnaire

Computer Vision Questionnaire
If you have trouble with your eyes while using a computer please fill out and bring with you to your appointment. Computer Vision Questionnaire

Specialty Visits

Infant See
Please bring with you for child’s appointment. Circle anything that applies.
Download Infant See Form

Low Vision Eval
Bring with you for your low vision evaluation. Circle anything that applies.
Download Low Vision Eval

Low Vision Questionnaire
Please bring with you for your appointment. Circle anything that applies.
Download Low Vision Questionnaire