Register Online

At Mind-Body-World Optometry, 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.

  • Please download and fill out all needed forms.
  • Please contact our Administrative Support Team, to determine which forms you will need. [email protected]. (914) 874-1177.
  • Our current forms are fillable:  You may download forms, save them with your name, and return them to us via secure email to [email protected].
  • You may also print the forms to complete by hand, and return them via fax (914-885-1463) or scan/email to [email protected].
  • If completing by hand: Please remember to bring originals with you to the first appointment.

Fillable & Printable Forms:

New Patient Health History Form, Basic, Adult

New Patient Extended History Form – Children

New Patient Extended History Form – Adult

Record Release

Quality of Life Questionnaire

Educator's Checklist

Report Request

Adults with Strabismus Questionnaire

Brain Injury Visual Symptom Survey

InfantSee Intake

Directions via Public Transportation / train schedule / bus 20/21 schedule

HIPAA Privacy Policy

Download & Review Form

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Please do not submit any Protected Health Information (PHI).

Administrative Office Hours

Exams By Appointment Only


10:00 am - 6:00 pm


10:00 am - 6:00 pm


10:00 am - 6:00 pm




10:00 am - 6:00 pm


By Appointment