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Providing eye exams in Fayetteville, Hope Mills, Raeford,
Aberdeen, Jacksonsville, Ft. Bragg & Hendersonville, NC

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Exam Forms

Exam Forms

Do you want to drastically decrease the amount of time you will spend in our office?

Follow these easy steps!

  1. Find the right form(s) for you
  2. Click on "Download Form"
  3. Open the .pdf file on your computer with Acrobat Reader
  4. Fill out the electronic form to the best of your knowledge and we'll help with the rest
  5. Print out the form (or Save and print later)
  6. Bring the forms in with you for your visit

Find the Right Form(s) For You

Will you want a prescription for contacts? Download Form 

Will you be using Tricare, Medicare, or other insurances?


Tricare – Download Form

Medicare– Download Form

Other Insurance – Download Form

Not Using Insurance?

Intermediate Exam – Download Form




Because of the ongoing concern over the COVID-19 pandemic, the CDC has implemented specific guidelines for all eye practices. As a result, we are postponing all routine visits until further notice and only responding to urgent and emergent needs at this time. Many of our offices may soon be closed, but we will attempt to handle patient needs on a case by case basis. If you need an extension on a prescription for glasses, contacts, or medication, please email us at [email protected]. If you have an urgent need, you can try to reach us at 910.527.9519 and we will do our best to get back with you within an hour. Please leave your name, phone number, and the office you last visited. If for some reason our phone service is not working and we do not respond within an hour, please seek outside care. Thank you for your understanding. We look forward to returning to normal hours of operation as soon as it is safe to do so.