Please take a few
minutes to complete this Patient Welcome Form before you visit our office for
the first time. Once you fill in the information, click on the "Submit" button to e-mail it to our office
or bring a copy with you to your next appointment.
Eastgate Optical complies
with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age,
disability, or sex.
Si su lenguaje es
el Espanol, tenemos servicios de asistencia gratuita a su disponibilidad.