Staarmann Family Vision Center, Inc - Patient Forms

Patient Forms

Please print these forms, fill them out prior to your exam, and bring them with you. The third page is exclusive for our younger patients (adults may discard this form). Thank you.

This form contains our office policies, warranties and information on eyeglass prescription follow-ups.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. PLEASE REVIEW IT CAREFULLY.


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Staarmann Family Vision Center, Inc






Notice of Privacy Practices