Online Forms

At Effingham 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.

We ask that all of our new patients fill out the patient registration form, the Optomap consent form, and the practice policies consent form. The completed forms can be printed and brought with you to your appointment, faxed (888- 810-2083), or email us. If you are unable to complete the forms prior to your exam date, please arrive 20 minutes before your scheduled appointment time so that you can be seen in a timely manner.

Patient Registration Form

Practice Policies Consent Form

Medical Release Consent Form

Optomap Consent Form

Record Release Form
(for patients who need to transfer their records from another practice)

Tricare Benefits Explanation
(for patients who have Tricare as their primary insurance)

Privacy Policies

Contact Us

We look forward to hearing from you.

Hours of Operation

Our Regular Schedule


9:00 am-5:00 pm


9:00 am-5:00 pm


9:00 am-5:00 pm


9:00 am-5:00 pm


9:00 am-1:00 pm






Find us on the map

Read Our Reviews

  • "I’ve been going to Dr. Anderson for over five years now and even though I only see him once a year for my annual exam, he and his staff always make me feel very welcome and take care of all my eye care needs. Anderson Optometry is the best at what they do and make you feel right at home."

Newsletter Signup

Sign up for more articles