Patient forms

For a smooth first visit to our clinic, download, print and fill in the forms you need below
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For your convenience…

We have made several forms available for patients to download. If you are new to our practice, we encourage you to download and print out the new patient forms. Filling these out in advance of your first visit will minimize the time you spend in our waiting room.

If your doctor has given you a form with specific information or instructions different from the information on these online forms, rely on the information provided to you by your doctor, not on the online forms. If you’re not sure which forms you need, please call 717-657-2020 for assistance or click here to contact us.

If you’re unable to open these files, you probably need to download the free Adobe Acrobat Reader program.

Click on the forms you would like to download:

Can you be free from glasses and contacts?

The best way to find out if laser eye surgery is right for you is to book a free appointment. You’ll get a clear answer from our experts on your suitability and treatment options

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Recognized leaders in Harrisburg eye surgery

CHOOSE THE MOST EXPERIENCED CATARACT AND LASIK SPECIALISTS IN CENTRAL PENNSYLVANIA

Dr. Bennett Chotiner
M.D., F.A.C.S.

MEDICAL DIRECTOR, LASIK SURGERY, CATARACT SURGERY, GENERAL AND PAEDIATRIC OPHTHALMOLOGIST

Dr. Bennett Chotiner is the founder and medical director of Memorial Eye Institute. A noted innovator, in 1977 he established his clinical practice, the Pennsylvania Eye Associates. In 1984, he established the Pennsylvania Eye Surgery Center, Pennsylvania’s first …

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Dr. Erik A Chotiner
M.D., F.A.C.S.

GENERAL OPHTHALMOLOGY, CATARACT & REFRACTIVE SURGERY, LASIK SURGERY

Erik Chotiner, M.D. diagnoses and treats a wide range of medical eye conditions. He is a Phi Beta Kappa graduate of Franklin and Marshall College. Dr. Chotiner attended Jefferson Medical College in Philadelphia where he received multiple awards including the Physiology Prize for …

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Dr. Richard M. Kowalski
Dr. Richard M. KowalskiO.D
Dr. Kowalski is a specialist in comprehensive eye care, refractive surgery consultations and contact lenses…

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Dr. Kenneth H. Levin
Dr. Kenneth H. LevinM.D.
Dr. Levin is a specialist in cataract surgery, glaucoma and general ophthalmology

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Dr. Bradford K. Sgrignoli
Dr. Bradford K. SgrignoliD.O
Dr. Sgrignoli is a specialist in retina and vitreous disease & surgery, macular degeneration and diabetic retinopathy…

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Dr. Michael J. Silvetti
Dr. Michael J. SilvettiO.D
Dr. Silvetti is a specialist in comprehensive eye care, refractive surgery consultations, contact lenses and low vision consultations…

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Dr. Katherine Won
Dr. Katherine WonO.D
Dr. Won is a specialist in comprehensive eye care and contact lenses…

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