Prescott & Prescott Valley AZ Patient Forms

Looking for an optical shop with affordable glasses lens? Need eye disease detection and treatment? Call Rummel Eye Care, P.C. in Prescott AZ at 928-445-1341 or in Prescott Valley AZ at 928-775-4066.

We have provided some of our patient forms below. Patients should complete/print these prior to their appointment and take them to their appointment.

VSP Consent Form

Our VSP Consent form is for our new patients. The form allows us to gather the information we need about the individual to better treat them.

English

Patient Consent/HIPPA Form

All new patients will need to fill out the patient consent/HIPPA form which helps you to understand how we handle your personal information.

English - En Español

Financial Policy Form

Patients will need to fill out this form to show us that you understand and agree with our financial policy.

English - En Español

Call Rummel Eye Care, P.C. in Prescott AZ at 928-445-1341 or in Prescott Valley AZ at 928-775-4066 for a convenient appointment.

Prescott Office

Rummel Eye Care, P.C.
1022 Willow Creek Road | Suite 200 | Prescott, AZ 86301
(928) 445-1341
rec@rummeleyecare.net
Rummel Optical
(928) 445-4069
optical@rummeleyecare.net

Prescott AZ Optical Office Map

Rummel Eye Care Facebook Rummel Eye Care Twitter Rummel Eye Care Google Plus Rummel Eye Care Yahoo Local Rummel Eye Care Bing Local
Prescott Valley Office

Rummel Eye Care, P.C.
2517 Great Western Drive | Prescott Valley, AZ 86314
(928) 775-4066
rec@rummeleyecare.net
Rummel Optical

(928) 772-6246
optical@rummeleyecare.net

Prescott AZ Optical Office Map

Rummel Eye Care Facebook Rummel Eye Care Twitter Rummel Eye Care Google Plus Rummel Eye Care Yahoo Local Rummel Eye Care Bing Local

Hours: Monday–Friday 8am–12pm & 1:30pm–5pm, 24/7 Emergency Service

 

Service Areas Include: Prescott, Prescott Valley, Chino Valley, Dewey, AZ