Type Size

Westheimer Vision Associates

Patient Forms

Please print and complete this form. Bring it with you to your visit.

It is important that babies between six and 12 months of age have an exam to determine if they are at risk for eye or vision disorders.  Our doctors participate in InfantSEE, a program that provides free eye exams for babies up to 12 months.

You may complete this form before coming to our office for the first time.

 

 

 

 

 

 

 

  This PDF requires a free plugin that may have come included with your browser. If you are having difficulties opening this file Click Here to go to Adobe's web site for Acrobat Reader.