Patient Forms

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 18 years of age).

Adult Medical History Form

Child Medical History Form

Step 2: Please READ the Notice of Privacy Practice: Read online or Download/Print

Please Print and Sign the Acknowledgement Form

9:00am - 5:30pm 9:00am - 5:30pm 9:00am - 12:30pm 9:00am - 5:30pm 9:00am - 12:30pm Closed Closed optometrist # # # 1133 Westchester Avenue, Suite N008 White Plains NY 10605