Forms

For your convenience, we have made a number of forms available for patients to download. If you are new to our practice, we encourage you to download and print out the new patient forms. Filling these out in advance of your first visit will minimize the time you spend in the waiting room filling them out when you get here. Other forms are informational. If your doctor has given you a form with specific information or instructions different from the information on these online forms, rely on the information given to you by your doctor, not on the online forms. If you're not sure which forms you need, please call 717-657-2020 for assistance or email us your questions at 2020@memorialeye.com.

If you're unable to open these files, you probably need to download the free Adobe Acrobat Reader program, which is available at the following location: www.adobe.com/products/acrobat/readstep.html

Click on the forms you would like to download:

• Patient Information
• Laser Vision Correction Procedures Frequently Asked Questions
• Laser Vision Provider Checklist
• Amsler Grid (Home Test for Macular Degeneration)

2 Locations to Serve You:

Harrisburg Location: 4100 Linglestown Road, Harrisburg, PA 17112
Phone: (717) 657-2020 | (800) 382-2020 | Fax: (717) 657-2071 
Click Here to E-mail Us

West Shore Location: 4407 Carlisle Pike • Camp Hill, PA 17011
Phone: (717) 975-2015 | Fax: (717) 657-2071