Patient Forms

The Bernstein Center for Visual Performance and Family Vision Care Associates offer the following forms to be downloaded at your convenience prior to your visit to our offices:

Bernstein Center for Visual Performance

Step 1: ALL NEW PATIENTS should DOWNLOAD AND FILL OUT one of the two Medical History Forms listed below (Please Use the CHILD Form for any patient under 15 years of age).

Download / Print ADULT Medical History Form

Download / Print CHILD Medical History Form

Step 2: Please READ the Notice of Privacy Practice: Read online or Download/Print

Step 3: Please PRINT & SIGN the Acknowledgement below that you have been notified of your Medical Privacy Rights.

Please Print and Sign the Acknowledgement Form

Family Vision Care Associates - InfantSEE Program

If you wish to take advantage of a comprehensive vision exam for your infant (The InfantSEE Program), please use the forms (English or Spanish) listed below:

Download InfantSEE Form - English

Download InfantSEE Form - Spanish/EspaƱol