Patient Forms

Download, fill out, and either print these forms to bring to your next appointment with Dr. Clark or email them to us.

New Patient History Questionnaire

Patients with VSP
Editable PDF

Patients with Insurance Other than VSP
Editable PDF

Medicare Guide for Eye Care

HIPAA Notice of Privacy (Read Only)

Consent to Medical Treatment, Signature on File, Financial Agreement, & HIPAA Acknowledgement

Records Request Form