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Patient Registration Form

Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office. This form contains confidential information and is delivered to your doctor through a secure Internet connection.


Due to the Coronavirus outbreak we are closed indefinitely, and we apologize for your inconvenience. In the case of an ocular emergency please contact Omni Eye Services 404-257-0814 or seek care at your local urgent care center or emergency room.

Although we do not have access to our optometry office or your eye health records, we will be monitoring our email account at: for any questions or concerns that you may have.