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Patient Forms

Patient WELCOME Form
File Size: 1281 kb
File Type: pdf
Download File

The Patient WELCOME Form (above link) is the initial form that we need filled out for all of our patients.  
 
Save yourself some time at the office and simply print this out, fill it in, and bring it with you for your appointment!
Patient Assignment of Benefits Form
File Size: 829 kb
File Type: pdf
Download File

The Assignment of Benefits Form (above link) is mandatory for any patient that will be using any type of insurance, but also has an area for prescription information, so we do require it for every patient as well. 
 
This form can also be printed, so please bring it with you as well!
Contact Us
Fontana Eyecare Associates
16 Hampton Village Plaza
Suite 249
St. Louis, MO 63109
Phone: 314-353-6171
Office Hours
Mon    9:00 am - 5:00 pm
Tue     9:00 am - 5:00 pm
Thu     9:00 am - 5:00 pm
Fri       9:00 am - 5:00 pm
Sat      9:00 am - Noon
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