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(678) 253-7975

245 Peachtree Industrial Blvd Suite 103
Sugar Hill, GA 30518

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Patient Intake Form

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Gender

Insurance Information

Primary Insurance Type
Are you the Primary Insurance Policy Holder?

Why are you at Sweet View Optical today?

Reason for Today's Visit
Do you wear glasses and if so, how old are your current pair?
Do you wear contact lenses?
Are you interested in wearing contact lenses?
Do you have a backup pair of glasses?
Would you like thinner, lighter lenses for glasses?
Do you have sunglasses?

Medical History

Arthiris?
Diabetes
High Blood Pressure
Skin Disorder
Allergies
Cataracts
Glaucoma
Macular Degeneration
Cancer
Heart Disease
Thyroid Disease
Asthma
Blindness
Eye Disease/Injury
Lazy Eye
Eye Surgery
Are you Pregnant or Nursing?

Contact Info

245 Peachtree Industrial Blvd Suite 103

Sugar Hill, GA 30518

(678) 253-7975

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Office Hours

Monday 10:00 AM - 6:00 PM
Tuesday 10:00 AM - 6:00 PM
Wednesday 10:00 AM - 6:00 PM
Thursday 10:00 AM - 6:00 PM
Friday 12:00 PM - 7:00 PM -(By Appointment Only)
Saturday 11:00 AM - 3:00 PM -(By Appointment Only)
Sunday Closed

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