At Kunesh Eye Center, 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 Free AdobeReader®
- 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.
Patient History Record
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.
Consent for Release of Medical Information
Acknowledgement of Receipt of Privacy Practices
Patient Privacy Practices
If you have any questions, please do not hesitate to contact our office by calling (937) 298-1703.