Online Forms

At Kueber 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 AdobeReaderĀ® to download and complete the forms.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Email your printed and completed form(s) to our office at [email protected] or bring them with you to your appointment.

HIPAA Privacy Policy

Download & Print Form

Authorization to Bill Insurance

Download & Print Form

Medical History Form

Download & Print Form

Contact Lens Rebate Forms

Bausch + Lomb Rebate Form
CooperVision Rebate Form