Patient Forms

At Eye Associates, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.​​​​​​

  • You will need AdobeReader® to download and complete the forms.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.
NOTE: The HIPAA form is for your information only. You do not need to fill out or bring with you.


​​​​​​​New Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

Download & Print New Patient Form

Existing Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

Download & Print Existings Patient Form

HIPAA Form

Please review this HIPAA form and keep for your records.

HIPAA

admin none 8:00 AM - 5:00 PM 8:00 AM - 5:00 PM 8:00 AM - 5:00 PM 8:00 AM - 5:00 PM 8:00 AM - 5:00 PM 8:00 AM - 5:00 PM 8:00 AM - 5:00 PM optometrist # # # 8925 Metcalf Ave Overland Park Kansas 66212 (913) 261-9985 (913) 261-9976 northoverlandpark@seetheclarity.com https://goo.gl/maps/8Qq8cjPDRvEx93YA7 https://www.4patientcare.ws/wsv3pro/web/webschedulerv3.aspx?SessionID=29070168&Gcount=0 https://www.google.com/search?q=eye+associates+of+north+overland+park&rlz=1C5CHFA_enUS766US766&oq=eye+associates+of+north&gs_lcrp=EgZjaHJvbWUqCQgAECMYJxiKBTIJCAAQIxgnGIoFMg0IARAuGK8BGMcBGIAEMgYIAhBFGDkyDQgDEC4YrwEYxwEYgAQyBwgEEAAYgAQyDQgFEC4YxwEY0QMYgAQyBwgGEAAYgAQyBggHEEUYPNIBCDQ5OTVqMGo3qAIAsAIA&sourceid=chrome&ie=UTF-8#lrd=0x87c0eb3331f6564b:0xfca10540924d1551,1,,,, https://www.yelp.com/biz/eye-associates-of-north-overland-park-overland-park https://goo.gl/maps/4x3EJpXtJLLkz5eT7 https://goo.gl/maps/vJLfBStC5vHS67ZLA https://goo.gl/maps/WaJkeTd1aHKajbWt6 https://goo.gl/maps/c7ujWqqAb5RpzpeRA https://goo.gl/maps/RzAupKzw3so4XFN3A https://goo.gl/maps/Yw7v4mfTZk7i9XtE8 https://goo.gl/maps/FoKpgHRd2o9aHz6y5 https://yourstore.wewillship.com/?account_id=1274 https://www.4patientcare.ws/wsv3pro/web/webschedulerv3.aspx?SessionID=29070037&Gcount=0