Please Send to Patient
Check the boxes next to any of the forms, education hand outs, and/or agreements that need to be emailed to the patient.
Patient Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Patient Email
example@example.com
The following forms, hand outs, and/or agreements need to be sent to the patient's email:
Contact Lens Education Form
CRT Patient Agreement Form
Dilation Waiver
Notice of Privacy Practices
Blinking Exercises for Dry Eye
PVC Dry Eye Questionnaire
OSDI Questionnaire
Other
Submit
Should be Empty: