Patient Forms

Patient Forms - Bernstein Center for Visual PerformanceFor your convenience, The Bernstein Center for Visual Performance and Family Vision Care Associates offer the following forms to be downloaded at your convenience prior to your visit to our offices:

Bernstein Center for Visual Performance

STEP 1:  ALL NEW PATIENTS should DOWNLOAD AND FILL OUT one of the two Medical History Forms listed below (Please Use the CHILD Form for any patient under 15 years of age).

ADULT download / print ADULT Medical History Form

download / print CHILD Medical History Form
(Under 15 years of age)

Step 2:  Please READ the Notice of Privacy Practice:   Read Online  |   Download/Print

Step 3:  Please PRINT & SIGN the Acknowledgement below that you have been notified of your Medical Privacy Rights.

Please Print and Sign the Acknowledgement Form

 

InfantSEE Program offered by our sister practice, Family Vision Care Associates

Family Vision Care Associates - InfantSEE Program

If you wish to take advantage of a comprehensive vision exam for your infant (The InfantSEE Program), please use the forms (English or Spanish) listed below: 

InfantSEE Form - English Download InfantSEE Form - English
InfantSEE Form - Spanish Download InfantSEE Form - Spanish/Espanol

 

Member - American Optometric Association Accredited by College of Optometrists in Vision Development Member - New York State Optometric Association
Certified - American Optometric Association - Sports Medicine Accredited by The Optometric Etension Program Foundation Member - American Optometrist Association - Contact Lens Division