At Neuro-Ophthalmology of Texas at Eye Wellness Center, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.
- You will need AdobeReader® to download and complete the forms. Download the Free AdobeReader®
- Download the required form(s). Print out the form(s) and complete the required information.
- Fax your printed and completed form(s) to our office or bring them with you to your appointment.
New Patient Health History Form – Required
Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.
If you have any questions, please do not hesitate to contact our office by calling (713) 942-2187.
Online Forms
To better prepare us for your visit please CAREFULLY answer the history questionnaire.
Please click here to download this questionnaire, as well as our other office forms, and spend the time necessary to answer all the questions to the best of your knowledge so that we may help you with your condition. We are looking forward to seeing you!
Notice Regarding Disability Papers
Our providers and their staff DO NOT fill out any type of disability paperwork. If you require this, we will be happy to refer you to someone who can help you.
Consultation Request Form
Referring physicians and their office staff may download this form to fill out and fax to us so we may contact your patient(s) to schedule an appointment with us (MediCare and MediCaid included).
The Forms
Below you will find a few office forms available to download for completion prior to your visit. Completing these forms before you arrive at our office can save you up to an hour on your appointment time in some cases. You may also be instructed to download these if you have access to the internet.
Please do not fill these forms out on the computer (digitally). Please print them using adobe reader and complete them with pen and paper. Sorry for any inconvenience, we find that the print comes out jumbled and out of alignment if the form is completed incorrect digitally.
Complete Packages
Below are complete packages you will need if you are a first time patient. You do not need these forms if you are on MEDICARE or MEDICAID. Please be sure you choose the correct package: ADULT or MINOR.
Forms in Spanish
Email Communication