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At Samantha Slotnick OD, FAAO, FCOVD, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete some of the forms. Click here to download.

  • Download the required form(s). Print out the form(s) and complete the required information.

  • Fax your printed and completed form(s) to our office, and please bring originals with you to your appointment.


Online Forms:

New Patient Registration:
Adult    /     Child

Quality of Life Questionnaire

Vision Therapy Changes Checklist

Personal History, Adult


Printable Forms:

New Patient Health History Form, Basic, Adult

New Patient Extended History Form – Children

New Patient Extended History Form – Adult

Record Release

Educator's Checklist

Report Request

Adults with Strabismus Questionnaire

InfantSee Intake



HIPAA Privacy Policy

Download & Review Form



Download the Free AdobeReader®