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At Effingham Eye Care, 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. Click here to download.
  • 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.

We ask that all of our new patients fill out the patient registration form, the Optomap consent form, and the practice policies consent form. The completed forms can be printed and brought with you to your appointment, faxed (888- 810-2083), or email us.  If you are unable to complete the forms prior to your exam date, please arrive 20 minutes before your scheduled appointment time so that you can be seen in a timely manner.

Patient Registration Form

Practice Policies Consent Form

Optomap Consent Form

Record Release Form
(for patients who need to transfer their records from another practice)

Tricare Benefits Explanation
(for patients who have Tricare as their primary insurance)

Privacy Policies

Exclusive Offer

THIS ---->https://effinghameyecare.imatrixbase.com/online-forms.html

Office Hours

Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9:00am 9:00am 9:00am 9:00am 9:00am Closed Closed
5:00pm 5:00pm 5:00pm 5:00pm 1:00pm Closed Closed

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