972-625-2020

It is Easy to Schedule an Appointment.
All You Have to do is Text or Call Us at

Patient Forms

Because we know your time is valuable, please fill out these forms and bring them to the appointment with you. If you have any questions, fill out as much as you can and we will be happy to assist you when you arrive.

* = required field































    Primary Correction





    Patients Ocular History

    (please check the following that apply, or "None")

    At least one option needs to be checked.

    Cataracts


    Retinal Detachment


    Macular Degeneration


    Crossed Eyes/Lazy Eye


    Glaucoma


    Dry Eyes


    None

    Family Ocular History

    (please check the following that apply, or "None")

    At least one option needs to be checked.

    Cataracts


    Retinal Detachment


    Blindness


    Crossed Eyes/Lazy Eye


    Glaucoma


    Macular Degeneration


    None

    Patient Medical History

    (please check the following that apply, or "None")

    At least one option needs to be checked.

    Diabetes


    High Blood Pressure


    Heart Disease


    Arthritis


    Cancer


    Kidney Disease


    High Cholesterol


    Stroke

    None




    Family Medical History

    (please check the following that apply, or "None")

    At least one option needs to be checked.

    Diabetes


    High Blood Pressure

    Heart Disease


    Arthritis

    Cancer


    Kidney Disease

    High Cholesterol


    Stroke
    None


    Social History

    Please provide an answer to all drop downs.





    Review of Systems

    Are you currently experiencing problems with the following?

    Please provide an answer to all drop downs.

    • “The staff were all professional and polite, there was no wait time. I highly recommend The Colony Vision Center.”

    • “I had something in my eye and Dr. Myers was able to fit me in quickly and remove the object. I also received a very thorough eye exam while I was there. The staff and Dr. were very friendly and professional.”

    • “Took the family got right in at appointment time Doctor was great. Very informative the first glasses I have had that I can see and it is great.
      Amazing customer service. Very very friendly staff. Definately will be bringing my family in.”

    • “Came in with a broken pair, received 20% discount on new frames. Walked out satisfied.”

    • “I have been going there for 15 years and Dr. Lee Ann Myers is a breath of fresh air! I will keep going back!”

    • “I had a wonderful experience just last month with Dr. Myers.”

    • “Dr. Lee,Ann Myers was absolutely great. I heartily recommend The Colony Vision Center.”

    • “I went last week and go again tomorrow. She is Fantastic. She spent a lot of time with me. For the first time she confirmed I can wear contacts. Was so patient and very informative!”

    4709 State Hwy 121 #122 | The Colony, TX 75056 | Directions | 972-625-2020