Rx Confirmation Form
Thank you for choosing Professional VisionCare for your vision care! Please sign below to acknowledge your understanding of your right to have access to your eyeglasses and/or contact lens prescription(s) at any time.
Patient Name
*
First Name
Last Name
Date
*
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Month
-
Day
Year
Date
Office Location:
Westerville Office
Johnstown Office
The Solution Center
Lewis Center Office
By signing below, I understand that I have access to my eyeglass and/or contact lens prescription(s) at any time.
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