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 AdobeReader® 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
Download   Page 1 and Page 2 or PDF File

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 and Print Page 1 and Page 2

Download the Free AdobeReader®

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





Discrimination Policy


Reviews From Our Satisfied Patients

  • "I Have been coming to Holicki Eye Ceners for two years and recently had cataract surgery. All the staff who saw me were considerate and friendly, What stads out most of the care they provided was that Dr. Holicki prayed before surgery."
    Blaine - Angola, Indiana