Skip to main content
Home » Patient Center

Patient Center

Welcome to our patient center! We strive to make your experience at our office as convenient and pleasant as possible. This area of our website provides the information about what to expect at your appointment. In addition, the forms required at the time of your visit are available online to provide the convenience of completing them in the comfort of your home prior to your appointment.

PERSONAL HEALTH RECORD

Visit www.RevolutionPHR.com to:

  • View your demographics and clinical summaries
  • Review and confirm your appointments
  • Check the status of you eyeglasses and contact lens orders
  • Access account status and billing statements
  • Utilize server messaging with the doctor

If you do not have a username and password, please contact our office.


ONLINE FORMS

We want to get your eye examination started soon after you arrive. To help process your paperwork, we ask that you click on the appropriate link below.  You can complete and print the form or submit it electronically.  This form will allow us to better assess your eye health and visual needs.  What questions, concerns, or goals can we help you with? Let us know!

Attention Internet Explorer Users: our online forms are not supported in your browser. Please open our website in a different browser such as Chrome, Firefox or Safari, or choose the "Download & Print Form" option.

New Patient, Adult Form - Download & Print FormSubmit Online

Previous Patient, Adult Form - Download & Print FormSubmit Online


New Patient, Child Form - Download & Print Form | Submit Online

Previous Patient, Child Form - Download & Print Form | Submit Online


Office and Discrimination Policies - Download & Print

According to the National Optometric Association (NOA) and the Center for Disease Control (CDC), it is strongly recommended that all non-urgent optometric care be suspended at this time.  Therefore we will be closed starting March 18th, 2020.  We will remain closed until we are advised to reopen.  If you have an urgent matter, eye emergency, or are in need of assistance, we are always willing to help in any way possible.  Please call the office at 702-456-9585 for updated instructions.