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!

Recently Had Cataract Surgery with Us?

Print Cataract Drops Instructions

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


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


8:00 am-5:00 pm


8:00 am-5:00 pm


8:00 am-5:00 pm


8:00 am-5:00 pm


8:00 am-5:00 pm