Online Forms

Hollingsworth Family Eye Care offers our patient form(s) online so they can be completed in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print it out and fill in the required information.
• Fax us your printed and completed form(s) or bring it with you to your appointment.

Case History for Adults Form

Case History for School - Aged Children Form

HIPAA Form

VIP Member Registration Form - Optional

This form can be filled out to register for access to the members only section of our website. You can also sign up for our monthly newsletter to keep up on current vision issues, as well as receive special promotions and invitations to VIP events in our office. Print out this form and bring it with you to our office.  If you prefer, Click Here and register online instead!  The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form