STAARMANN FAMILY VISION CENTER, INC
  • Home
  • Our Practice
  • Our Services
  • Schedule Appointment
  • Patient Forms
  • Promotions
  • Contact Us
  • Order Contact Lenses
  • Eye Care Articles

Patient Forms

Patient Forms

Please complete and bring to exam.
Welcome Sheet
File Size: 341 kb
File Type: pdf
Download File

History Form
File Size: 435 kb
File Type: pdf
Download File

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.
HIPAA STATEMENT
File Size: 292 kb
File Type: pdf
Download File

This form contains our office policies, warranties and information on eyeglass prescription follow-ups.
Patient Policies Form
File Size: 107 kb
File Type: pdf
Download File

Contact Us
Staarmann Family Vision Center, Inc
2834 Mack Rd.
Fairfield, OH 45014
Phone: 513-874-1718
Fax: 513-870-5600

Office Hours
Mon    8:00 am - 7:00 pm
Tue     9:00 am - 6:00 pm
Wed   8:00 am - 4:00 pm
Thu     8:00 am - 5:00 pm
Fri       CLOSED
Sat      9:00 am - 12:00 noon
Notice of Privacy Practices
Website by Eyefinity
  • Home
  • Our Practice
  • Our Services
  • Schedule Appointment
  • Patient Forms
  • Promotions
  • Contact Us
  • Order Contact Lenses
  • Eye Care Articles