Registration Form

Visit Information

Do you have private insurance? *

Medical History

Do you have any medical conditions? *
Are you taking any prescription medications? *
Do you have any allergies to medications? *
Have you had any surgeries on the eyes or been diagnosed with any eye conditions? *
Do you smoke? *

OCT (Optical Coherence Tomography) allows a painless scan of the Retina and Optic Nerve. This scan is as important to the eyes as an MRI is for the brain. OCT is a safe and valuable tool that can help ensure your eye health.

Important Information About Opting Out of OCT: You understand that by declining the OCT scan, you are waiving the opportunity to utilize a valuable diagnostic tool that can assist in the early detection of eye disease. Early detection of eye disease can significantly improve treatment outcomes and potentially prevent vision loss.

Helps us personalize your care.
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OCT imaging is strongly recommended

Based on the health information you entered, OCT imaging can help detect sight-threatening changes early—often before you notice symptoms.