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Online Patient Registration Form

Please complete the information below and submit the form online. This form contains confidential information and is delivered to your doctor through a secure Internet connection.

IMPORTANT- WHAT YOU SHOULD BRING TO YOUR APPOINTMENT! ALL PATIENTS MUST BRING ALL GLASSES INCLUDING SUNGLASSES TO THEIR APPOINTMENT! CONTACT LENS WEARERS: MUST WEAR THEIR LENSES TO THEIR APPOINTMENT AND BRING ALL GLASSES INCLUDING SUNGLASSES! NEW PATIENTS MUST BRING CONTACT LENS BOXES AS WELL!

Please ensure you also fill out either the Child Visual Efficiency Checklist or the Adult Visual Efficiency Checklist as applicable. If applicable, please fill out the Neuro-Related Visual Skills Checklist as well.

Contact Information

Personal Information

Eye History

Glasses History (Skip if you don't wear glasses.)

Contact Lens History (Skip if you don't wear contacts.)

Medical History

Primary Insurance

Please bring all insurance cards with you to your appointment.

Secondary Insurance

If you have coverage through another plan/organization, please fill in the details below.

Privacy Policy

Patient Portal

THIS ---->https://holisticvision.imatrixbase.com/new-patient-center/online-forms/contact-us-form.html

Office Hours

DayOpenClosed
Monday10 am7 pm
Tuesday9 am6 pm
WednesdayVT OnlyVT Only
Thursday9 am6 pm
Friday9 am2 pm
SaturdayBy Appt.By Appt.
SundayClosedClosed
Day Open Closed
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
10 am 9 am VT Only 9 am 9 am By Appt. Closed
7 pm 6 pm VT Only 6 pm 2 pm By Appt. Closed


 

Patient Portal

Testimonial

"Dr. Sapossnek is an excellent optometrist. She has my complete trust. She is so thorough in her exams and includes parents in conversation and education, so I know and understand all the facets of my children's vision. All of the above [in the Patient Satisfaction Survey are] EXCELLENT, no need to elaborate. I feel fortunate to have found Dr. Sapossnek and am glad all of us can go to her-both for my child with vision therapy needs, daughter and I with glasses, and son who needs neither."

Benjamin
Huntingdon Valley, PA

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