Patient Forms

At Lake Havasu Family Eyecare, we’re here to help you with all your eye care needs. Save time at your next appointment by filling out all the necessary intake forms beforehand!

All our online forms are completely secure and printable.

Complete Eye
Exam Form

We won’t overlook anything when it comes to your eye exam. Fill out this form to give our team a better understanding of your eyes and vision before your appointment.


Get the medical aspect of your eye exam covered with Medicare. Fill out the form below so we can make sure your information is up to date.

Contacts Lens
Exam Form

If you’re interested in contact lenses or currently wear them, this form will help us either update your prescription or find the best pair for you.

Your Family’s Dependable Western Arizona Eye Care Provider

When you visit Lake Havasu Family Eyecare, you’ll be treated by western Arizona’s finest and most passionate eye care professionals. Your experience is important to us, which is why we go the extra mile in everything we do to ensure that you and your family are always cared for and that your eyes are in great shape.

What Our

Patients Are Saying

” Very friendly and knowledgeable staff. I felt very comfortable there and all my questions were answered. So glad I picked Lake Havasu Family Eyecare for my eye care! “

– B.H.