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Patient Forms

Berks Eye Physicians & Surgeons, Ltd.

We are very pleased you have chosen Berks Eye Physicians & Surgeons to care for your eyes. It is our privilege to provide excellent medical care in a pleasant, friendly, patient-centered environment. Our practice offers a broad scope of medical and surgical eye services including state-of-the-art cataract surgery and glaucoma management. We provide comprehensive family vision care, contact lens examinations, and dispense glasses and contact lenses. Emergency eye care is available 24 hours a day. Berks Eye has extremely qualified physicians and surgeons, certified technicians and opticians, and a caring support staff ready to assist you.

Please bring the following to your appointment:

  • Current medical and vision insurance cards
  • Insurance referrals if required
  • Photo identification
  • List of medications that you use, their dosage, and frequency
  • Method of payment for copays and other charges due on the day of service (we accept cash, checks, VISA, Mastercard, Discover, and American Express)

If you are a new patient, when your appointment is made you will be forwarded information on how to complete registration paperwork by logging into the Berks Eye Portal.  If you do not have internet access or do not get the opportunity to complete paperwork before your arrival – you will complete your paperwork on an ipad after arrival for your appointment. Any paperwork that requires signature  – such as payment policy and HIPAA paperwork will need to be signed on the ipad after arrival  – even if you do Portal registration.

Your initial examination will take between 1-3 hours depending on the complexity of your examination. As a standard part of your visit, our technician may use drops that will enlarge your pupils. These “dilating” drops will cause light sensitivity and some blurring for several hours. We recommend having a driver for your trip home. Patients less than 18 years old must be accompanied by a parent or legal guardian.

If you are a current contact lens wearer, if possible, please bring a copy of your prescription or your boxes/vials with you to your appointment. Please also bring any back-up eyeglasses you may wear on occasion.

Please call us at (610) 372-0712 if you have any questions. Thank you for allowing us to participate in your eye care. We look forward to meeting you!

Please click on one of the links below to download the corresponding form:

NEW PATIENT REGISTRATION FORM (.PDF)
(.PDF files can be downloaded, printed, filled out and brought to your appointment.)

MEDICAL RECORDS RELEASE

MINOR MEDICAL CONSENT FORM

ADDRESS:
1802 Paper Mill Road Wyomissing, PA 19610
PHONE:
FAX:
(610) 376-6968
OFFICE HOURS
Monday
8:00 am - 7:00 pm
Tuesday
8:00 am - 5:00 pm
Wednesday
8:00 am - 5:00 pm
Thursday
8:00 am - 7:00 pm
Friday
8:00 am - 5:00 pm