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At Yancey Eye 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. Click here to download.
  • 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.

Patient History Form

Download & Print Form


Parental Authorization Form

Download & Print Form

Any child under the age of 18 must be accompanied by an adult and the adult must remain in the office with the child at all times.

If someone other than the parent will be bringing the child for their appointment a Parental Authorization Form must be filled out and signed by the parent.  Please click on the above link to print the form and complete. The adult bringing the child must present this form and identification in order for the child to be seen by the doctor.


Download the Free AdobeReader®

Exclusive Offer

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New patients receive 15% OFF first visit.

*Excludes all vision and insurance plans.

Sign-up using the form or call us at 912-537-4400 to take advantage of this exclusive offer.

Make Appointment

We will do our best to accommodate your busy schedule. Request an appointment today!

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