Submit Your Form Electronically

Fill out the Patient Information and Health History Form electronically before your appointment at Wainwright Eye Care. Our online forms are secure and HIPAA compliant. You can also download and print our Patient History Form and bring it with you to your appointment. 


*Please note* 

If you do not see the confirmation page after you have pressed the submit button, then an error may have occurred in transmission. If you do not see the confirmation page, please re-submit your information. Thank you!


Types of Services:

Comprehensive eye examination: A full health evaluation of the eyes including dilation(*see below for further description). Your eyes will be checked for a wide range of conditions such as glaucoma, cataracts, macular degeneration, dry eyes, ocular allergies, diabetic/hypertensive eye disease and retinal disease. An updated glasses prescription will be given as well that can be used anywhere to get new glasses made. Comprehensive examinations should be done on a yearly basis unless more frequent exams are recommended.

Contact lens examination: Comprehensive examination must be done within 6 months of contact lens examination. They can both be done on the same day if desired. If you have had a comprehensive exam done at another office we must have a copy of that exam(not just the glasses Rx) before doing just the contact lens exam. This examination includes a trial pair of lenses if needed, evaluation of contact lens fit and check of vision in the contacts. All follow up exams are included if done within 45 days. After that time a $25 fee will be charged for each follow up. After all follow up care is completed a copy of your contact lens prescription will be given to you. At that time you can purchase lenses from our office or any other contact lens retailer. Be sure to ask us about rebates available!

Medical office visit: Visit for diagnosis and treatment of acute red eyes, eye injuries, eye infections, acute vision changes and other medical related eye issues. Final fee depends on amount of testing required.

Foreign body removal: Removal of particles(metal, wood, etc…) from cornea or conjunctiva. Typically will require at least one follow up exam.

Dilation Information:

Dilating drops enlarge your pupils to give the doctor a more comprehensive view of the retina in the back of your eye as well as check your glasses Rx. Dilation allows your doctor to detect eye diseases easier, such as glaucoma, macular degeneration, cataracts, retinal tears/holes and others. Systemic illnesses, such as high blood pressure and diabetes can also be detected during a thorough dilated eye exam. Dilation is recommended every year for people with a family history of eye disease, diabetics, anyone over 50 or people with an Rx over -5.00. Symptoms following dilation include light sensitivity and blurred vision at near and typically last 3-4 hours.