Online Forms
Advanced Eyecare Professionals offers our patient form(s) online so they can be completed in the convenience of your own home or office.
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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.
New Patient Health History Form - Required
This lets us know the history and current state of your health. What questions, concerns, or goals regarding your vision can we help you with? Let us know!
Download & Print Form
New Patient Information Form - Required
This lets us know who you are and how you heard about us. Who can we thank? General questions concerning emergency contacts, insurance providers and privacy policies are outlined in this form.
Visual Screening Form - Optional
Our office has acquired some new and highly sophisticated computerized instruments
that aid us in providing the best available healthcare for you and your family. If you are interested in these screenings being performed please fill out the following form.
Notice of Privacy Practices Form - Required
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Release of Confidential Information - Required
This form enables Advanced Eyecare Professional Staff to authorize the release of any glasses, contacts or other information regarding appointments at the request of the individual.
Eye 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. Click here to register! 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!
Patient Satisfaction Survey - Optional
We are always trying to improve and would value any feedback on how we can do so. Feel free to download this survey and either mail it to one of our offices, stop by and drop it off, or email it to our practice administrator. Email
Serving Vision Care Needs Since 1984
Breast Cancer Awareness
Our office has special Pink Lens Cleaning Cloths with the awareness ribbon on them. The clothes are available for a minimum donation of $2. At the end of the month a check with all the donations will go directly to the American Cancer Society.Member Login
HASTINGS: (269) 945-3866
IONIA: (616) 522-1000
LOWELL: (616) 897-7000
NEW SHERIDAN Clinic - Call Ionia or Lowell offices to schedule appointments for Sheridan
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