Patient Forms

Patient Forms

COVID-19 UPDATE:

At Stoughton Eye Care & Eyewear, it is our mission to provide our patients with quality care in a high-end, clean and comfortable environment, as well as to ensure the health and safety of our patients, employees and our community.

When you come to your appointment, our office will look different. We have placed protective shields at our front desk and have removed most of the waiting chairs, books, toys and magazines. We did this to allow ample social distancing. Our doors will be locked and we will only be allowing a limited number of patients in the office at a time. Please call once you arrival, and please have anyone who accompanies you to wait in the car or outside the office.

What we request of our patients:
  • Fill out your paper forms before your exam, this will help to reduce your time in the office.
  • Call the office once you arrive.
  • Wear a face mask the entire time in our office. If you do not have a mask, one will be provided for you.
  • We will verify with you verbally that you have not been feeling ill or have been around anyone who has been ill or has traveled to a COVID-19 hot spot.
  • We ask that you either wash your hands for a minimum of 20 seconds with soap and water or use our provided hand sanitizer once you enter into our office.
  • We will check your temperature.


What we’re doing:
  • We will be wearing gloves and a face mask.
  • Only allowing a limited number of patients in the office at a time.
  • Increasing the frequency and extent of our cleaning practices, such as additional wipe downs of all hard surfaces, frames and equipment using Hypochlorous acid that is an EPA approved disinfectant against the virus that causes COVID-19. This will be done between each patient.
  • Continuing to wash our hands frequently with soap and water for a minimum of 20 seconds.
  • Requiring any staff person with elevated temperature, illness or having high risk factors to stay home.
  • Closely monitoring the advice and guidance from the Centers for Disease Control (CDC) and the World Health Organization (WHO).

In order to prevent any further spread of the coronavirus:

Please reschedule your appointment if you have been ill or have been around anyone who has been ill.

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For your convenience, you can either print or fill out new patient forms before your first office visit. If you have any questions please give us a call at 608-205-6810 or Contact Us online.

If you do not wear contact lenses please fill out form below:
Online questionnaires and privacy practices to be completed before exam

If you do currently wear contact lenses please fill out form below:
Online Questionnaires and Privacy Practices to be completed before exam

Notice of Privacy Practices

COVID-19 UPDATE:

At Stoughton Eye Care & Eyewear, it is our mission to provide our patients with quality care in a high-end, clean and comfortable environment, as well as to ensure the health and safety of our patients, employees and our community.

When you come to your appointment, our office will look different. We have placed protective shields at our front desk and have removed most of the waiting chairs, books, toys and magazines. We did this to allow ample social distancing. Our doors will be locked and we will only be allowing a limited number of patients in the office at a time. Please call once you arrival, and please have anyone who accompanies you to wait in the car or outside the office.

What we request of our patients:
  • Fill out your paper forms before your exam, this will help to reduce your time in the office.
  • Call the office once you arrive.
  • Wear a face mask the entire time in our office. If you do not have a mask, one will be provided for you.
  • We will verify with you verbally that you have not been feeling ill or have been around anyone who has been ill or has traveled to a COVID-19 hot spot.
  • We ask that you either wash your hands for a minimum of 20 seconds with soap and water or use our provided hand sanitizer once you enter into our office.
  • We will check your temperature.


What we’re doing:
  • We will be wearing gloves and a face mask.
  • Only allowing a limited number of patients in the office at a time.
  • Increasing the frequency and extent of our cleaning practices, such as additional wipe downs of all hard surfaces, frames and equipment using Hypochlorous acid that is an EPA approved disinfectant against the virus that causes COVID-19. This will be done between each patient.
  • Continuing to wash our hands frequently with soap and water for a minimum of 20 seconds.
  • Requiring any staff person with elevated temperature, illness or having high risk factors to stay home.
  • Closely monitoring the advice and guidance from the Centers for Disease Control (CDC) and the World Health Organization (WHO).

In order to prevent any further spread of the coronavirus:

Please reschedule your appointment if you have been ill or have been around anyone who has been ill.


For your convenience, you can either print or fill out new patient forms before your first office visit. If you have any questions please give us a call at 608-205-6810 or Contact Us online.

If you do not wear contact lenses please fill out form below:
Online questionnaires and privacy practices to be completed before exam

If you do currently wear contact lenses please fill out form below:
Online Questionnaires and Privacy Practices to be completed before exam

Notice of Privacy Practices