Appointment Forms for our Eye Exams

For your convenience, the following forms are readily available for you to download and print. At the time of your appointment, we request that you provide us with completed copies of the following Welcome Form, Medical History Questionnaire, and Patient History. 

Please be sure to bring all insurance information at the time of your appointment. We will make copies of your insurance card(s) at that time.




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Location

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Hours of Operation

Our Regular Schedule

MA Shurtz OD & Associates

Monday:

8:00 am-5:30 pm

closed for lunch 12:00 pm to 1:00 pm

Tuesday:

8:00 am-5:30 pm

closed for lunch 12:00 pm to 1:00 pm

Wednesday:

8:00 am-5:30 pm

closed for lunch 12:00 pm to 1:00 pm

Thursday:

8:00 am-5:30 pm

closed for lunch 12:00 pm to 1:00 pm

Friday:

8:00 am-1:00 pm

Saturday:

Closed

Sunday:

Closed