Online Forms

At CENTRAL IOWA EYE CARE, 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. Click here to download.
  • 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 at (515)576-0224, or bring them with you to your appointment.

New Patient Health History Form – Required

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 your have regarding your eye health or vision on the form.

Download & Print Form


Download the Free AdobeReader®

Fort Dodge Office

Monday:

8:00 am-5:00 PM

*Evening appointments available

on the 2nd & 4th Monday of ea. mo.

Tuesday:

8:00 am-5:00 PM

Wednesday:

8:00 am-5:00 PM

Thursday:

8:00 am-5:00 PM

Friday:

8:00 am-5:00 PM

Saturday:

Closed

Sunday:

Closed