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Patient Registration

Patient Registration Form and Appointment Checklist

We know how busy you are!  You can save time by having your patient registration and health history form completed prior to your appointment.  Be sure to complete the form in its entirety and bring it with you to your appointment.  Here is a checklist of items to bring that will make your visit much more efficient:  

Checklist

  • Patient Registration Form
  • Current eyeglass or contact lens prescription
  • Eyeglasses or contacts you are currently wearing
  • Insurance information, co-pay and insurance card(s)
  • For your convenience, you can make online appointments! 

 

Emmerich Vision Care
(608) 274-6747 | Fitchburg, WI
Providing eye exams, contact lenses, designer eye wear and sunglasses in the Madison, Verona and Fitchburg WI area since 1981.

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