• Personal Information

  • The mission of Union Family Eye Associates is to contribute to a lifetime of healthy vision, providing each patient with the highest quality vision care and consequent quality of life.  The visual needs and wellness of each patient will always be our first priority. Everything we do shall communicate this. The information and questions below will remain confidential, and are critical to the evaluation of your vision and health. Therefore it is very important that every question be answered in detail. Thank you.

  •  -
  •  -
  •  -
  • ............................................................................................................................................

  • MEDICAL INFORMATION

    Please check boxes that may apply
  • CHECK ANY MEDICAL CONDITIONS THAT APPLY TO YOU
  • CHECK ANY EYE CONDITIONS THAT APPLY TO YOU
  • CHECK ANY CONDITIONS THAT ARE PRESENT IN OTHER FAMILY MEMBERS
  • Many people experience a variety of symptoms after working at their computer for some period of time. If you answered yes to any of the questions above, there is a new type of eyewear lens that can eliminate the symptoms and dramatically improve your comfort level when working on a computer. These eyewear lenses result from a new vision testing technology, developed specifically for computer users, which our office has been trained and certified to use. Please make sure to discuss these issues with the doctor.

  • Contact Lens History and Questionanaire
  • Ocular Wellness Exam

  • Our doctors order (a) Laser Confocal Imaging (b) Cross Sectional Scan and (c) Pigment Density Testing of Macula - as part of your comprehensive eye exam. These advanced technologies are used by the doctors to detect early signs of retinal disorders, including but not limited to: glaucoma, cancer, diabetic retinopathy, high blood pressure, macular degeneration, and retinal detachment.
    By perfoming these test, the doctors will likely not dilate your eyes unless the test reveals undetected eye disease. It is particularly helpful when you return for your annual exam as it provides a permanent record of your retinal condition, and each subsequent year the images can be viewed side by side to discover subtle changes and monitor your continuing eye health. There is a $55 copay associated with this procedure.

  • Retinal Photography
  • Check One
  • Clear
  • Reload
  • Should be Empty: