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Patient Forms

Downloadable patient forms that you can print and fill out before your next visit to Place Eye Care in LeRoy.

For your convenience, we have created the following pages to provide you with a list of the insurance carriers we accept at our LeRoy optometric office, as well several downloadable forms to save you time at your next appointment.

Downloadable Forms

  • Patient Information Form [PDF]
  • Medical History Form [PDF]
  • Endodontic Information and Consent Form [PDF]
  • Notice of Privacy Practices Form [PDF]
  • Acknowledgement of Receipt of Privacy Practices Form [PDF]