Patient Forms and Resources

Grand Rapids eye doctor giving an eye exam to a new patient

We always strive to make your experience at Georgetown Eye Associates as convenient and pleasant as possible.

When you arrive at our office we will ask you to update any changes in your personal and health information.

If you are making your first visit we encourage you to complete the forms below prior to your visit. If you print hard copies of your paperwork please bring it completed to your appointment. Thank you for helping us prepare for your appointment. You can click the links below to view and download our patient forms.


Authorization for Release of Previous Records

HIPAA Privacy Policy

Medical History Questionnaire

Insurance Information

Vision Insurance

Many of our patients have vision insurance for eye examinations, eyeglasses and contact lenses. We participate with several insurance companies and we are glad to process your claim for you and help you with the details.

Medical Insurance

Our office also participates with several health insurance companies that provide coverage for medical visits at our office. We are happy to process your insurance forms for you and answer any questions you may have.

Flexible Spending Plans

Flex Spending is a program created by the government which allows you to put away pre-tax dollars in an account for use on medical care, eye exams, glasses, contact lenses, and LASIK. We provide detailed statements so that you can submit your claims for reimbursement.

Care Credit

As a service to our patients, we are pleased to offer the Care Credit card. Care Credit allows you to begin your vision care today with low monthly payments. Click the Apply Now link or visit our staff for more details.

Make a Payment

We accept Cash, Checks, and Credit Cards.