alarm-ringing ambulance angle2 archive arrow-down arrow-left arrow-right arrow-up at-sign baby baby2 bag binoculars book-open book2 bookmark2 bubble calendar-check calendar-empty camera2 cart chart-growth check chevron-down chevron-left chevron-right chevron-up circle-minus circle city clapboard-play clipboard-empty clipboard-text clock clock2 cloud-download cloud-windy cloud clubs cog cross crown cube youtube diamond4 diamonds drop-crossed drop2 earth ellipsis envelope-open envelope exclamation eye-dropper eye facebook file-empty fire flag2 flare foursquare gift glasses google graph hammer-wrench heart-pulse heart home instagram joystick lamp layers lifebuoy link linkedin list lock magic-wand map-marker map medal-empty menu microscope minus moon mustache-glasses paper-plane paperclip papers pen pencil pie-chart pinterest plus-circle plus power pushpin question rain reading receipt recycle reminder sad shield-check smartphone smile soccer spades speed-medium spotlights star-empty star-half star store sun-glasses sun tag telephone thumbs-down thumbs-up tree tumblr twitter user users wheelchair write yelp youtube

Adults (18+ yrs old): 

  • Insurance Cards (All)
    • Medical
    • Vision
  • Primary Insured Information:
    • Social Security Number
    • Date of Birth
    • Address
    • Phone Number
    • Employer
  • Patient Social Security Number
  • Current Medication List
  • Any glasses you currently use
    • Daily Wear
    • Readers
    • Sunglasses
    • Safety/Occupational Glasses

 

Children (17 yrs & under)

  • Legal Parent/ Guardian (must be present)
  • Legal Parent / Guardian Information:
    • Social Security Number
    • Date of Birth
    • Address
    • Phone Number
    • Employer
  • Custody /Guardianship Papers
  • Insurance Cards (All)
    • Medical
    • Vision
  • Primary Insured Information
    • Social Security Number
    • Date of Birth
    • Address
    • Phone Number
    • Employer
  • Patient Social Security Number
  • Current Medication List
  • Any glasses you currently use
    • Daily Wear
    • Readers
    • Sunglasses
    • Safety/Occupational Glasses