Thank you for choosing Spring Hill Eyecare!

To save time, please fill these forms out prior to your appointment.

 

If you are able to, please fax these forms to 931-489-1953 or email to frontdesk@springhilleyecare.com

Medical History Form
Medical History.pdf
Adobe Acrobat document [44.5 KB]
Welcome Form for Adults
Welcome Form-Adults.pdf
Adobe Acrobat document [155.2 KB]
Welcome Form for Children <18 years old
Welcome Form-Children.pdf
Adobe Acrobat document [198.4 KB]
InfantSEE Patient History Form
InfantSEE®, a public health program, managed by Optometry Cares® -The AOA Foundation, is designed to ensure that eye and vision care becomes an essential part of infant wellness care to improve a child's quality of life. Under this program, participating doctors of optometry provide a comprehensive infant eye assessment between 6 and 12 months of age free of charge regardless of family income or access to insurance coverage.
InfantSEEPatientHistoryForm.pdf
Adobe Acrobat document [30.2 KB]
Lifestyle Index - neurolens
This questionnaire is meant to help your doctor understand what you're experiencing on a regular basis - whether it's caused by your eyes, posture, stress, etc. Your responses will help make sure you receive the best care possible.
Lifestyle Index neurolens.pdf
Adobe Acrobat document [134.3 KB]
Age-Related Macular Degeneration (AMD) Risk and Symptoms Assessment
AMD is the leading cause of vision among older Americans. It is a progressive condition that causes a part of your retina called the macula to deteriorate with age. The macula is responsible for your central vision, which allows you to do things like read, watch TV, recognize faces and drive.
AMD Risk and Symptom Assessment Form.pdf
Adobe Acrobat document [369.4 KB]

Also, please bring the following:

  1. Your current pair(s) of glasses - even if you feel the prescription is not corect, the lenses are scratched or the frame is damaged.  Also, please bring your sunglasses.
  2. Your current contact lens parameters - if you don't have a copy of the prescription, bring the boxes the lenses came in.  Also, know the name of the contact lens solution you use.

If unable to print out the patient forms ahead of time, please arrive 10-15 minutes prior to your scheduled appointment time to fill out the forms in the office on an iPad mini.

(Exception: if your appointment time is at the same time as we open or return from lunch).

 

You will need to know the following:

  1. Your medical insurance and vision plan cards or information.  Please call ahead to ensure that we currently accept your plan.
  2. Contact information about you (or your child): name, home/work address, home/work/cell/emergency phone #s, social security #.
  3. Date of last medical and eye exams.  Names of your primary care physician and previous eye doctor.
  4. History of any medical or eye diseases for you and your immediate family (parents, siblings, children, grandparents, aunts/uncles. 
  5. A list of your current medications and dosages - both prescription and over-the-counter.  Also. any allergies.

If you would like your records sent to or from our office, please fill out this release form. 

Medical Records Request.pdf
Adobe Acrobat document [104.1 KB]

HIPAA / Privacy Policy

NOTICE OF PRIVACY PRACTICES (non-brochur[...]
Adobe Acrobat document [142.0 KB]
HIPAA signature page.pdf
Adobe Acrobat document [109.8 KB]

Because of so many new procdures and protocols, our online scheduler is still temporarily disabled.  We feel it is better to review these over the phone at this time. 

Contact Us

Spring Hill Eyecare, PLLC

5238 Main Street

Spring Hill, TN 37174

(formerly 5328 Main Street)

 

Call us at 931-489-1950 or use our contact form.

Business Hours

Mon: 10am-7pm

Tue: 10am-7pm

Wed: 9am-6pm

Thu: 7am-4pm

Fri: 7am-4pm

 

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