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Patient Forms

Sparks Eye Care is moving to a simple digital intake process. Before your visit, we will send you a secure link by text or email so you can complete your forms from home. It only takes a few minutes and means less time filling out paperwork when you arrive.

A stack of paper intake forms on a desk next to an iPad with a cabinet and plants in the background

How the Digital Forms Work

  • After you schedule, the office sends a secure link by text or email.
  • Click the link and fill out your intake forms from any phone or computer.
  • Forms take about five minutes for returning patients, a bit longer for new patients.
  • If you prefer to fill out forms in person, arrive about fifteen minutes early and our team will help you get set up.

Completing your forms ahead of time lets Sparks Eye Care spend more of your appointment time on your eyes, not paperwork.

woman at a wooden front desk talking to two women sitting in chairs in front of her

Complete Your Patient Forms

To save time at your appointment, please complete the forms below before your visit. Select the form you need and fill it out online — it only takes a few minutes.

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Please complete all fields below. This information helps us provide the best care possible.

Patient Information

Patient Name *
Date of Birth *
Gender
Home Address *
Marital Status
*

Emergency Contact

Emergency Contact Name
Emergency Contact Address (if different from patient)

Appointment Reminders

I prefer to receive my appointment reminders by:

Additional Information

Billing Information (if different from patient)

Name of Insured / Responsible for Account
Date of Birth (Insured)
Address (if different from patient)

Primary Insurance

Policy Holder Date of Birth (if different from patient)

Secondary Insurance

Policy Holder Date of Birth (if different from patient)

Authorization & Assignment of Benefits

I hereby authorize the release of any medical information to process all claims, and request payment of any medical benefit to be paid to Sparks Eye Care, LLC.
Acknowledgment *
Signature of Patient/Guardian *

Questions About Your Forms

Not sure how to answer something, or would you rather handle the paperwork in person? Call us at (316) 600-7891 and we will walk you through it.

Call (316) 600-7891