Wichryk Eye Associates, P.C.

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  • Services
    • Comprehensive Exams & Contact Lens Evaluations
    • Medical Exams
    • Contact Lenses
    • Ortho-K and Specialty Lenses
    • Neurolens
  • Technology
  • Optical
  • Patient Forms
  • Location
  • Home
  • About Us
  • Services
    • Comprehensive Exams & Contact Lens Evaluations
    • Medical Exams
    • Contact Lenses
    • Ortho-K and Specialty Lenses
    • Neurolens
  • Technology
  • Optical
  • Patient Forms
  • Location

Our Patient Forms

New Patient Forms. Please bring completed forms with you to your appointment. Also remember to bring your current Rx glasses and/or your current contact lens information.  

Appointment Protocol - COVID-19
File Size: 190 kb
File Type: pdf
Download File

Patient Information Form
File Size: 337 kb
File Type: pdf
Download File

Medical History Questionnaire
File Size: 272 kb
File Type: pdf
Download File

HIPAA
File Size: 215 kb
File Type: pdf
Download File

Coordination of Benefits
File Size: 211 kb
File Type: pdf
Download File

Optomap
File Size: 291 kb
File Type: pdf
Download File

Picture
6451 Village Lane, Suite 200
Macungie, PA  18062
Current hours as of 02/01/2021
*All In-Office Visits By Appointment Only*

Monday: 8:30 am - 5:00 pm
Tuesday: 11:30 am - 8:00 pm
Wednesday: 8:30 am - 5:00 pm
Thursday: 8:30 am - 5:00 pm
 Friday: 8:30 am - 2:00 pm
​Saturday/Sunday: Closed

Contact Us
610-965-1800
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