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Online Forms

Forms

Welcome and we are honored you have chosen H. Rubin Vision Center for your vision and eye health needs. At H. Rubin Vision Center, we value your time. In an effort to save you time in our office, you can download and complete our patient form prior to your appointment. Please arrive 10 minutes before your appointment and bring the following items with you:

  • Your glasses and sunglasses
  • Current contact lens prescription or boxes
  • Vision benefits information (if applicable)
  • All Health Insurance cards
  • Driver's license or photo ID
  • List of all the medications you are taking including supplements
  • Form of payment for services. We accept cash, personal check, money order, Visa, MasterCard, Discover, American Express, and Care Credit
  • You will need AdobeReader® to download and complete the form. Click here to download.
  • Download the required form. Print out the form and complete the required information.
  • Fax your printed and completed form to our office or bring them with you to your appointment.

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.

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Special Offer: Get TWO pair of glasses for the price of ONE!

Special Offer cannot be combined with insurance

Location

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Office Hours

Monday:

8:00 am-5:30 pm

Tuesday:

8:00 am-5:30 pm

Wednesday:

8:00 am-5:30 pm

Thursday:

8:00 am-5:30 pm

Friday:

8:00 am-4:00 pm

Saturday:

Closed

Sunday:

Closed