New Patient Information

Information for New Eye Patients in State College, Pennsylvania

When you come for your appointment, please bring the following items with you:

Your insurance cards
Your driver's license or other photo ID
Referral form from your primary care physician, if required
List of current medications with dosage and frequency
List of current eye drops
Current glasses

*During the course of treatment, in order to provide a thorough eye examination, the doctor may have to dilate your pupils. This can temporarily affect your vision.

Fill Out the Forms Below

Complete the 5 forms below. Print the forms and bring with you to your appointment, submit them below or you can also save and email them to patient@heimereye.com .

*You must DOWNLOAD and SAVE the BLANK form to your computer first before typing any of your information into the form.

1. Download and save the BLANK form to your computer

2. Reopen the file and fill out your information

3. Save again

4. Attach the new form to an email or submit file below.

*The newest version of Adobe Reader is needed to type directly into the forms.

Patient Information Form

Patient Medical History Form

Current Medication List Form

HIPAA- Privacy Information Form

Notice of Privacy Practices

Financial Responsibility Notice

Completed Forms

Once you have completed all the required paperwork, you may submit them here. Required fields below.

Ask Us Anything

If you have any questions about our services or the type of treatment you might need, please give our friendly staff a call. We will be happy to help.

Give Us A Call

Schedule an Exam

Give Heimer Eye Care a call today and talk to the experts in eye and cataract treatments.

Call Us (814) 234-1002
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