Online Forms

At Virginia Eye Center, PC, we value your time. In an effort to save you time in our office, you have the option to download and print out the registration forms or submit them online.

Online Forms - Preferred Method 

New Patient Forms - Please scroll all the way to the bottom. There are a total of 4 forms including a registration form, medical history and 2 pages of consents.  You must click on the Submit button at the bottom of each form for a total of 4 times.

Information and Consent for Dilated Exam and Information and Consent for Refraction

Cataract Forms - For Cataract Consult Appointments Only

Request for Medical Records

Cataract Contact Lens Questionnaire & Topography Consent

*Additional information about appointments - Please wear a mask. If you do not have one, we will provide you with one. Please remain in your car in our parking lot until called by a member of our staff. If it is 10 minutes past your appointment time and you have not been called, please call the office at 703.858.9800.

Downloadable Forms

  • You will need AdobeReaderĀ® 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.

  • Email your completed forms to, fax them to 703.858.9801 or bring them with you to your appointment. For everyone's safety and to expedite your appointment, we strongly prefer to receive them in advance of your appointment if possible.
  • New Patient Forms

    Cataract Questionnaire - For Cataract Consult Appointments Only

    Contact Lens Agreement - New Wearer

    Contact Lens Agreement - Established Wearer

    Request for Medical Records


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