New Patient Form


If you would like to become a new patient, please complete this form and press submit. Once you complete the form, you will be able to print the form and bring it with you when you visit our offices. We encourage all new patients to complete this process online to reduce your wait time and to give you the best possible care. All of your information will be kept secure and strictly confidential and adheres to HIPAA privacy standards. We look forward to seeing you in the office.

Telephone #

Please Complete If Under 18 Years of Age Or a Student


The only way we can sort out whether reduced vision is a matter of a simple eyeglass adjustment or some other problem is to perform a REFRACTION. This measures the eyes' focusing ability. This is the familiar "better one or two" part of the exam where you look at the eye chart through the PHOROPTER. (pictured below).

The rest of the eye exam, THE MEDICAL EYE EXAM, determines if there are other disorders or conditions causing difficulties. Both the MEDICAL EYE EXAM AND THE REFRACTION ARE ABSOLUTELY NECESSARY TO FULLY EVALUATE THE HEALTH OF YOUR EYES AND THE VISUAL SYSTEM. Why am I being charged a "REFRACTION FEE"?

Medicare and most other insurers will not pay for this vital part of the eye exam and will only reimburse for THE MEDICAL EYE EXAM component. The REFRACTION component has been made the patient's responsibility.

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  Our Locations

Ft. Pierce
2201 S. 10th St.
Ft. Pierce, FL 34950
(772) 461-2020
FAX: (772) 468-2134
Port St. Lucie
1302 SW St. Lucie West Blvd.
Port St. Lucie, FL 34986
(772) 340-2929
One Day Surgery Center
1715 SE Tiffany Ave.
Port St. Lucie, FL 34952
(772) 905-3422
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Port St. Lucie
1715 SE Tiffany Ave.
Port St. Lucie, FL 34952
(772) 335-3939