Thank you for choosing Eye Physicians & Surgeons of Arizona.

This form is divided into 4 sections. Please fully complete all sections.

Please bring the following to your appointment:

• Photo ID
• Insurance Card
• List of Medications (if any)

Anyone attending the appointment will be required to wear a face mask.

For cataract evaluations, please remove soft contact lenses at least 48 hours prior to your appointment and please remove hard lenses (gas permeable) at least 2 weeks prior to your appointment.

If you have any questions, please contact our office.