Whether it’s your first visit to Jarvis Vision Center or you’ve been here many times, you’ll need to fill out some paperwork. Below, you’ll find all the forms you need to complete prior to your appointment.


Patient Forms and Appointments in Jarvis Vision Center

Fill Out Paperwork Ahead of Time
for Faster Appointments!

We always want to make the best use of your time while you’re at Jarvis Vision Center. When you fill out your paperwork at home ahead of time, it allows the check-in process to go quicker, and you’ll get right to facetime with your doctor, picking out glasses, or whatever else has brought you in.

It’s also easier to access information you might need to put on the forms while you’re at home, and to make sure you don’t forget anything!

Patient Forms

The Forms You'll Need

You’ll need the following forms, available for download here:

New Patient Paperwork (5 Pages) — Includes Personal History, Acknowledgement of Financial Responsibility, HIPAA Agreement, and Request for Medications List

Jarvis Vision Center Notice of Privacy

Patient Forms

How to Submit Your Paperwork

We have several convenient ways to get your patient forms to our Murray, KY office.
Our Patient Portal is a fast and secure way to send us your documents electronically. Once you’ve signed up online, it’ll also give you access to your patient information, including your account balance, exam results, and optical orders. We encourage everyone to sign up for our Patient Portal!

Fax: (270) 759-1493

Email: info@jarvisvision.com

Mailing address: 1806 N 4th St, Murray, KY 42071

You can also simply bring the forms with you the day of your appointment! Please call (270) 512-8388 if you have any questions about form submission.

Insurance Verification & Assistance

We make taking advantage of your insurance easy! We accept most insurance plans, but before you come to our office, you should check our insurance page to be sure yours is on the list. Our staff is well-equipped to answer any questions you might have about your specific coverage when you call (270) 512-8388.

We look forward to seeing you soon!