Patient Information

Once you or your referring doctor has made your appointment with us, we will send you an information packet or you may fill out the patient information and medical history form online. Please fill out this information online or complete the paper work prior to coming in for your appointment. Your first appointment with us may take approximately two hours. For your convenience, you can download patient registration forms directly from our web site.

 Please click from one of the buttons below to complete New Patient Registration or Update your Patient Information.

Please read all of Commonwealth Eye Care Associates COVID-19 Protocols prior to your appointment.

 These forms require the free Adobe Reader to view and print. You can download the Adobe Reader by clicking the box below.

You may fill out the Patient Registration online by following the link below:

» New Patient Registration and Medical History  

OR you may print the forms and mail them to our office:

Patient Registration Form

Patient Medical History Information

Map to West End Office

Map to Tri Cities Office

Additional Forms: 

CECA Record Release Form

CECA Record Receive Form

Right to Receive a GFE

Virginia-NSA Form Disclosure

Notice of Privacy Practice