Patient Forms

Online Forms

​We value your time! In an effort to save you time in our office, you can download and complete our patient form prior to your appointment.

  • You will need AdobeReader® to download and complete the form.
  • Download the required form. Print out the form and complete the required information.
  • Bring the completed form with you to your appointment and please arrive a few minutes earlier than your scheduled appointment time to allow our staff to process your information.

New Patient Form

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals you have regarding your eye health or vision on the form

Print & Complete Form – Established Patient Form

Print & Complete Form – New Patient Form

Print & Complete Form – COVID-19 Consent rom

Call Us

Location

Massapequa Optometric Care
532 Broadway
Massapequa, NY 11758

Hours

Mon: 10:00AM - 7:00PM
Tues: 10:00AM - 5:00PM
Wed: 10:00AM - 6:00PM
Thur: 10:00AM - 7:00PM
Fri: 10:00AM - 5:00PM
Saturday: 9:00AM - 2:00PM
Sunday: Closed