Patient Forms

Kilgore Vision Center

The following forms are provided to our patients as a time saving step. You may review the following forms, fill out on screen, print and bring to our office to speed up your initial visit. Please note these forms are not emailed to our office automatically. You must print them and return to our office for Kilgore Vision Center to receive any of the information. Thank you!

Please read the following documents. These are for your information only and do not require any patient information or signatures. Thank you!

  • Patient Data Sheet
  • Patient Information
  • Review of Physical Health / Family History

Please read the following documents. These are for your information only and do not require any patient information or signatures. Thank you!

  • Contact Lens Prescription Renewal Guidelines
  • Identify Theft Prevention & Detection
  • Notice of Privacy Practices
  • Website Privacy Notice

HSC Ambulatory Surgery Center

  • Advance Directives
  • Notice of Privacy Practices
  • Patient Bill of Rights

 

HSC Ambulatory Surgery Center
The surgery centers offer the latest surgical technology and are conveniently located next to the eye clinics.
Doctors
Our doctors, including optometrists and ophthalmologists, are focused on eyes and patient care.
Our Locations
Serving north-central Arkansas and southern Missouri, we have offices in Harrison and Mountain Home. Come see us!