At Ephrata Eye Care, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

New Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals you have regarding your eye health or vision on the form.

Download & Print Form


Download the Free AdobeReader®

Hours of Operation

Monday

8:30 am - 5:00 pm

Tuesday

8:30 am - 5:00 pm

Wednesday

8:30 am - 5:00 pm

Thursday

8:30 am - 5:00 pm

Friday

8:30 am - 5:00 pm

Saturday

Closed

Sunday

Closed

Monday
8:30 am - 5:00 pm
Tuesday
8:30 am - 5:00 pm
Wednesday
8:30 am - 5:00 pm
Thursday
8:30 am - 5:00 pm
Friday
8:30 am - 5:00 pm
Saturday
Closed
Sunday
Closed

Our Location

Contact Us

We look forward to hearing from you