Patient Forms Please enable JavaScript in your browser to complete this form. - Step 1 of 4Are you an existing Optic Gallery patient? *Yes I am.No, I am a new patient.Do you know which location you belong to? *Optic Gallery Stephanie StreetOptic Gallery Water StreetContinueDo you currently wear contact lenses?Yes, I wear contact lenses.No, I don't wear contact lenses.PreviousContinueDo you currently have Medicare insurance? Yes, I do have Medicare insurance.No, I don't have Medicare insurance.PreviousNextFILL IN ALL THE FORMS BELOWAll forms below are mandatory. All forms have to be completed in order to process your patient file correctly. Once all the list is done, please press the submit button below. Patient History Form Open Form Here Check this box when the form is completed then click Submit