/find-us/new-patient-form/ New Patient Form Skip to main content
Home » Find Us » New Patient Form

New Patient Form

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • GENERAL HEALTH

  • EYE HISTORY

  • (WITHOUT CORRECTION)
    YesNo
    Blurry Vision at Distance
    Blurry Vision Close-Up
    "Halos" Around Lights
    Poor Night Vision
    Poor Color Vision
    Flashes of Light
    Dry Eye
    Seeing Double
    Floaters or spots
    Frequent Headaches
    Watering Eyes
  • MedicationCondition 
  • (If someone other than self)
  • Date Format: MM slash DD slash YYYY
  • Signature of Patient or Parent/Guardian
  • Date Format: MM slash DD slash YYYY
  • Signature of Patient or Parent/Guardian
  • Date Format: MM slash DD slash YYYY
  • Signature of Patient or Parent/Guardian
  • Date Format: MM slash DD slash YYYY
  • Signature of Patient or Parent/Guardian
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Signature of Patient or Parent/Guardian
  • Date Format: MM slash DD slash YYYY

Welcome to Texas State Optical Spring Klein

 
Appointment Form
Call (832) 251-7709 ▸
Take Me There

Our Location

21195 Kuykendahl Rd
Spring, TX 77379

Book an Appointment

Call (832) 251-7709 ▸

  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
  • :
  • This field is for validation purposes and should be left unchanged.