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W. Bellfort, Harlem, and Grand Pkwy
Home » Contact Us » Online Forms

Online Forms

At Grand Eye Care, we value your time. In an effort to save you time in our office, you can complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to complete the forms.
  • Complete the required information then print the forms.
  • Please 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.

Download & Print Form


Download the Free AdobeReader®

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At Grand Eye Care, we respect the ‘Stay at Home’ order and care deeply about the health and safety of our patients. In order to promote safe distancing and stop the spread of COVID-19, our office has closed to all non-emergent visits for the remainder of April 2020. We are still available to answer phone calls and offer curbside pick-up of glasses and contact lenses. Thank you for your understanding as we navigate this crisis together.

Sincerely,

Dr. Jennifer Bui and the Grand Eye Care family