Patient Forms

At Holt Eye Clinic, 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 the Free AdobeReader®
• 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.

Patient Health History Form

Download & Print Form

Patient Registration Form

Download & Print Form

Children's Registration Form

Download & Print Form

Patient Permission Form 

Download & Print Form

Current Medication List

Download & Print Form

Download the Free AdobeReader®