Holicki Eye Centers
& Optical

Forms Page

Welcome to the Forms Page

For Holicki Eye Centers, please print and fill out the following forms to bring with you to your initial appointment:



Information

HIPAA Information

Medical History Questionnaire

Are your eyes dry, itchy and feel tired?  You may have dry eyes.  Complete the following questionaire and bring with you to your exam:

Dry Eye Questionnaire

For Holicki Optical, please print and fill out the following forms to bring with you to your initial appointment:

Information

HIPAA Information

Medical History Questionnaire

 

General Information

NOTICE OF PRIVACY PRACTICES

IDENTITY THEFT POLICY

 

Coldwater
Angola
Sturgis
517-279-7927  
260-665-5015
269-659-4545

               

800-553-5497

Web Hosting Companies