Patient Forms

Please print and fill out the following forms. Save time at your appointment by bringing them with you when you come in for your exam.

Online Forms

Patient Registration Form

Financial Form

Optomap Form

ABN

HIPAA Privacy Form

HIPAA Acknowledgment

Printable Forms

HIPAA Acknowledgement

04/25/2022:

At this time our office is mask optional for patients and staff. Dr. Gore will continue to wear a mask in the exam room. If you would be more comfortable with our staff fully masking, please let us know when you schedule your appointment and we will be happy to do so.

We ask that if you or someone in your household is ill that you please reschedule your appointment.

We have implemented patient, staff screening protocols. Patients are required to wash their hands upon entering the office. Staff will sanitize every staff and patient contact area before and after each patient.
If you need to select new glasses or have glasses repaired we ask that you call first.
Patients under 18 years old may be accompanied by one parent.

David R. Gore, O.D., PC