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Online Forms

At Selma Eye Care, 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.

New Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

Download & Print Form


Download the Free AdobeReader®

Monday:

9:00 am-6:00 pm

Tuesday:

9:00 am-6:00 pm

Wednesday:

9:00 am-6:00 pm

Thursday:

9:00 am-6:00 pm

Friday:

9:00 am-5:00 pm

Saturday:

9:00 am-3:00 pm

Sunday:

Closed

Testimonials

Reviews From Our Satisfied Patients

  • "Great experience ! This was my second visit to Selma Eye Care and just like my first visit , it was great . Victoria and Kevin are amazing . The best service you will find ."
    Edward F.
  • "I am 73 years old and have had vision issues my whole life. This was my first experience with almost no anxiety. Thsnk you so much."
    Ellen J.