G&G Eye Doctors
Optometry & Optical

Reason For Visit

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? *

I Would Like To Opt-in For An Advanced Retinal OCT Image Today? *

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.

How did you hear about us? *

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Terms and Conditions Agreement for New Patients at G&G Optometry & Optical

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