Patient Forms

Patient Forms

Patient Forms

Patient Forms

Save time on your next visit. Please complete and submit our patient registration form prior to your scheduled appointment with our optometrists:​​​​​​​

HIPAA and Privacy Practices

Below please find our HIPAA and Privacy Practices that you may print

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    admin none 10:00 AM - 6:00 PM 10:00 AM - 6:00 PM 10:00 AM - 6:00 PM 10:00 AM - 6:00 PM 10:00 AM - 6:00 PM 10:00 AM - 5:00 PM 11:00 AM - 4:00 PM optometrist # # # 7014 East Camelback Rd. Suite 2000
    Scottsdale, AZ 85251 https://www.google.com/maps/place/Zmyslinski+Eye+%26+Contact+Lens+Center/@33.504024,-111.92796,16z/data=!4m5!3m4!1s0x0:0xe88661a4d6087b74!8m2!3d33.5040236!4d-111.92796?hl=en 5000 South Arizona Mills Circle Suite #165
    Tempe, AZ 85282 https://www.google.com/maps/place/Zmyslinski+Eye+%26+Contact+Lens+Center/@33.384634,-111.963497,16z/data=!4m5!3m4!1s0x0:0x7c49441f968830a8!8m2!3d33.3846339!4d-111.9634974?hl=en 4809459971 4808203813 https://www.lenscrafters.com/ScheduleExamView?catalogId=11651&clearExams=1&langId=-1&storeNumber=0552&storeId=10851 https://www.lenscrafters.com/ScheduleExamView?catalogId=11651&clearExams=1&langId=-1&storeNumber=0415&storeId=10851