Online Forms

At Holicki Eye Center & Optical, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReaderĀ® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

Patient Information Sheet

Download & Print Form


Medical History

Medical History Page 1

Medical History Page 2


Notice of Privacy Practice

Download & Print Form


Amsler Grid

Print Our Free Amsler Grid

Commonly used for Age-Related Macular Degeneration patients


Have Dry Eyes

Print Out Our Dry Eye Disease Information

About dry eyes and what you can do to help!


Having Cataract Surgery with Us?

Patients Having Surgery On A Monday

Patients Having Surgery On A Wednesday

For those of you that had cataract surgery with our clinic.


Want to share your experience?

Download and Print - Patient Testimonials


 

Optical Payment Policies - Refraction Fee Agreement


Download the Free AdobeReaderĀ®

Visit Our 3 Locations

Find us on the map

Hours

(Sturgis Office's Hours Vary - please call the office for more information)

Monday

8:00 am - 5:00 pm

Tuesday

8:00 am - 5:00 pm

Wednesday

8:00 am - 5:00 pm

Thursday

8:00 am - 5:00 pm

Friday

8:00 am - 5:00 pm

Saturday

Closed

Sunday

Closed

Monday
8:00 am - 5:00 pm
Tuesday
8:00 am - 5:00 pm
Wednesday
8:00 am - 5:00 pm
Thursday
8:00 am - 5:00 pm
Friday
8:00 am - 5:00 pm
Saturday
Closed
Sunday
Closed