Patient Forms

Patient Intake Form

Here at Modern Eye Care, we love meeting new patients. Part of easing your concerns is explaining what you can expect from our practice. When you are new to our office, we put in the effort to provide you with a positive and comforting experience. Once you have been with us for a while, you can continue to expect the highest level of service. We focus on providing quality optical care, excellent customer service, and a relaxing environment to maintain a lasting patient relationship. We consider your first visit the start of a long-term relationship with you.

Patient intake form


Care Credit Application

When to update and upgrade your eyeglasses should be the question, not how are you going to pay for it. To make that decision even easier for our patients, we offer the CareCredit ® card.  We partner with CareCredit to provide financing options to our patients. CareCredit is a payment option specifically for healthcare needs. You can use CareCredit for exams, contact lenses, and even eyeglasses.  CareCredit lets you upgrade your eyeglasses or contact lenses and then pay for them over time with low monthly payments that fit easily into your monthly budget. Now you don’t have to save up to get the eyewear you’ve always wanted.  CareCredit offers low minimum monthly payments and no up-front costs or pre-payment penalties.  To apply online, click the button below.

Care Credit Application


Notice of Privacy Practices

Every practice in the eyecare specialties North Texas network adheres to the privacy practices outlined in the link below.

Notice of Privacy Practices