Please fill out the following form if you are new to our office and are 13 years old or older. You may choose to email this document to our office when you have completed the requirements on the four pages. To do so, first save the completed form. Then, select the envelope icon on the top of the window. When prompted, select "attach a copy" to email. Please send the email and attachement to modernfamilyvision@sbcglobal.net. Or, you may print out the completed form and bring it with you to your appointment. To do so, click on the printer icon at the top of the window and follow the printing prompts.

Please fill out the following form if your child is coming to the office and is 12 years old or younger. You may choose to email this document to our office when you have completed the requirements on the four pages. To do so, first save the completed form. Then, select the envelope icon on the top of the window. When prompted, select "attach a copy" to email. Please send the email and attachement to modernfamilyvision@sbcglobal.net. Or, you may print out the completed form and bring it with you to your appointment. To do so, click on the printer icon at the top of the window and follow the printing prompts.

Please fill out the following form if you are a returning patient to our office. You may choose to email this document to our office when you have completed the requirements on the four pages. To do so, first save the completed form. Then, select the envelope icon on the top of the window. When prompted, select "attach a copy" to email. Please send the email and attachement to modernfamilyvision@sbcglobal.net. Or, you may print out the completed form and bring it with you to your appointment. To do so, click on the printer icon at the top of the window and follow the printing prompts.