After your conversation with Dr. Les to discuss your vision concerns and set up an appointment, you will be directed here for your history form. Print out and complete the applicable history form below, then fax, email, or mail your completed forms, along with any other additional reports, to our office. If sending additional reports is complicated or lengthy please bring them to your appointment.
Traumatic Brain Injury History Form
Third Party Payment Agreement Forms – For patients with third party payers such as workers compensation or auto insurance.
Please also note our Fragrance Free Office Policy: We have a fragrance-free office. Many of my patients with concussions and sensory issues become overwhelmed by perfume and cologne. They experience debilitating symptoms such as headaches, nausea, and brain fog that can linger all day. We’ve used peppermint essential oil to help patients who have experienced nausea or headaches in office. Please refrain from using fragrances to respect those patients with chemical sensitivity. Thank you.
Enter on 25th Street