Forms

Attention All New Patients??????????????????????????????????????????????????????????????????????????????????????????????

Please fill out the following on-line form:
Welcome to the Office Form

Children’s Forms
Download and print the following forms:
Children’s Questionnaire (PDF Format)
Infant Toddler Questionnaire ages 0-5 (PDF Format)

Brain Injury
Please print and fill out the following form if you have experienced any type of brain injury (example: concussion, stroke):
Brain Injury Vision Symptom Survey

Insurances we are providers for:

Medical
Summa
Anthem Blue Cross Blue Shield
Medicare

Vision
VSP Signature and Access Plans
EyeMed Access Plans

Exams

What to expect on the first appointment:
We strive to make your visit as enjoyable and pleasant as possible. In order to get a good eye health evaluation, Dr. Grant will most likely want to dilate your eyes. This can cause blurred vision and light sensitivity so make sure to bring your sunglasses or we will give you some. Your visit will take at least 1.5 hrs if your eyes are dilated.

In order for you and or your child to receive full attention, please refrain from bringing other siblings to the appointment.

For your first visit please bring:
All Current glasses and Current contact lens RX (or the boxes)
(daily wear, computer, sewing, sun etc), if you like an old prescription better, bring it and the newer one

For young children and those with attention difficulty:
Favorite DVD
Favorite small fixation target

For infants:
Favorite fixation targets
Favorite blanket/toy

Additional visits beyond the basic exam may be necessary if:

  • More information is needed than what can be attained during the basic exam
  • You or your child has special needs or concerns
  • Your child is struggling in school he/she may need a visual processing evaluation.
  • You or the patient have had a head injury or stroke

The PLUS of our practice Testing for More than 20/20 (done at all comprehensive exams)
20/20 simply means that a person can clearly see a letter a certain size at a 20 feet under high contrast. But there’s more to healthy vision and 20/20 and that’s the PLUS of our practice! Our comprehensive vision exam goes beyond 20/20 to evaluate many important visual skills, such as:

• Visual Acuity at Near
Is vision clear and single at close distances? Clear sight at short distances is critical to reading, writing, close work, computer use, etc.

• Eye Teaming Skills
Do the two eyes aim, move, and work as a coordinated team? Weaknesses in binocular (two-eyed) vision and eye teaming skills can cause numerous difficulties, including convergence insufficiency and poor depth perception.

• Eye Focusing Skills
Do the eyes maintain clear vision at varying distances? Rapid, automatic eye focus adjustment is critical to learning, reading, writing, sports, etc. Deficiencies can cause visual fatigue, reduced reading speed and comprehension, and/or avoidance of close work or other activities.

• Eye Movement Skills
Do eye movements show adequate muscle control, tracking, fixation, etc.? In the classroom, normal eye movements allow rapid and accurate shifting of the eyes along a line of print or from book to desk to board, etc. In sports, efficient eye movements contribute to eye-hand coordination, visual reaction time, and accurate tracking.