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Patient Forms

Patient Intake Form

To prepare for your first Eyetique appointment, print out and complete the patient history form. Bring it with you, along with your photo ID, insurance card, and any prescription eyeglasses or sunglasses.

Patient Intake Form

Out of Network Claim Form


Care Credit Application

Eyetique offers CareCredit financing options to make paying for your healthcare needs easy and convenient. CareCredit allows you to obtain eye exams, contact lenses, and glasses when you need them. You can also upgrade your glasses or contact lenses and pay for them with low monthly payments. There are no upfront costs or pre-payment penalties.

Care Credit Application


Notice of Privacy Practices

Notice of Privacy Practices