New Patient Zone

We look forward to meeting you at your appointment with Eye Care Associates.

Thank you for choosing Eye Care Associates.

New Patient Information

Save Time

To save time during your initial visit, we have made our New Patient Forms available online.

 

The process is easy as 1-2-3:

  1. Download and print the New Patient Forms (see instructions below).
     
  2. Complete the New Patient Forms at a time convenient for you.
     
  3. Bring the New Patient Forms along with your insurance information to your first appointment.
New Patient Information

Our doctors also ask each patient to bring the following:

  • Any eye glasses you currently wear
  • Back-up glasses for contact lens wearers
  • Any prescription or non-prescription sunglasses

New Patient Forms

Instructions

Please complete one (1) set of forms for each new patient:

Important Notice: Please save forms to your personal computer before completing.
Do NOT e-mail forms to our offices.

Click Here to download New Patient Forms as an Adobe® Acrobat® PDF File.

Requires Free Adobe® Acrobat® Reader® Version 4 or higher
To get your free copy from Adobe® Click Here

Request An Appointment

New and returning patients can request an appointment at any time.  Simply fill out the form below to request an appointment and we'll respond within 24 hours (next business day). Or, give us a call at any one of our North Carolina offices today.

Note:  This form is for NON-emergencies only.  Please do not use this form if you are experiencing an eye injury or other eye health complication.  Instead, please call our office at (919) 863-2020

Preferred Day and Time Specific Date?
Preferred Office Location  
 
Purpose of Visit  
 
Enter Special Request or Comments Below:
Patient Name(s): 
New Patient?:      
Relationship to Patient: 
First Name: 
Last Name:
Address:

  
Home Phone: () -
Work Phone: () -  Ext:
  Best Time To Call:
E-Mail:
Mobile/Other: