Manchester Eye Care Center

HIPAA Form 1105
Privacy Policy Acknowledgment 1105
Retinal Photos Form 1105
New Patient Information Form 1105

Printable forms are available in PDF format.
If you don't have Adobe Acrobat installed, click on the link below to get the free Reader.

Please fill out all printable forms and bring them to the office with you.

Please be aware this summer that travel time from the north may be affected by construction on M-52 between Chelsea and Manchester. This will include a lengthy detour between Scio Church and Pleasant Lake Roads. Consider alternate routes or plan on additional travel time to arrive at your appointment on time. Thank you!!

We all realize that sometimes emergencies may happen, making patients unable to keep a scheduled appointment. However, please note that any missed appointments or those that are canceled without 24 hours notice may be subject to a $20 no-show fee.