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Patient Forms

Access our patient forms that you can fill out before your next visit to Tri-County Vision in Willimantic.

A new patient to our practice will need the New Patient Form and Financial Policy. For children under the age of 12, please fill out the Children’s Vision Questionairre in place of the New patient form. Please read our Notice of Privacy Practices.

Our Forms

We will need to know if you take any medications, please either know the names or bring a list. It would also be helpful if you would bring any current glasses or sunglasses to your appointment. If you are a contact lens wearer, please bring your contact lens prescription or boxes with you.

Please be advised that the Doctors both strongly recommend the Optomap, Digital Retinal Photography.  It allows the doctor to evaluate the health of the back of your eye, the retina. It is used to detect diseases, such as Diabetes & Macular degeneration.  It is critical to confirm to health of the retina, optic nerve, & other retinal structures.  The Optomap is $39 and is usually not covered by insurances.  Thank you!