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 18 years of age).

Adult Medical History Form

Child Medical History Form

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

Please Print and Sign the Acknowledgement Form

Symptoms Quiz

Coming soon!
​​​​​​​The Bernstein Center for Visual Performance provides a wide array of specialized testing for vision problems.

Learn More

Contact Info

1133 Westchester Avenue, Suite N008
White Plains, NY 10605
(914) 682-8886 (914) 948-0365

Office Hours

  • Monday, Tuesday, Thursday
    9:00am - 5:30pm
  • Wednesday & Friday
    9:00am - 12:30pm
  • Saturday & Sunday
    Closed
© 2024 Bernstein Center for Visual Performance All rights Reserved - Accessibility Statement - Privacy Policy -
Powered by:
Roya
9:00am - 5:30pm 9:00am - 5:30pm 9:00am - 12:30pm 9:00am - 5:30pm 9:00am - 12:30pm Closed Closed optometrist # # # https://goo.gl/maps/zEfF4ikZ6ydTJ5QEA 1133 Westchester Avenue, Suite N008 White Plains NY 10605