Wallace Optometry Associates
  • Home
  • Our Practice
  • Our Services
  • Location
  • Eye Care Articles
  • Promotions
  • Patient Forms

patient  forms

Patient Forms


Adult History Form - Comprehensive Eye Exam
File Size: 303 kb
File Type: doc
Download File

Pediatric (Age 0-18) History Form - Comprehensive Eye Exam
File Size: 308 kb
File Type: doc
Download File

Medical History Form - Medical Office Visit (not a routine eye exam)
File Size: 308 kb
File Type: doc
Download File

Contact Us
Wallace Optometry Associates
1431 2nd Avenue, North
Bessemer, AL 35020
Phone: 205-425-5182
Office Hours:
Mondays           8:30am-5:00pm
Tuesdays          8:30am-5:00pm
Wednesdays     9:00am-5:00pm
Thursdays         8:30am-5:00pm
Fridays             CLOSED

Saturdays         By Appointment
Notice of Privacy Practices
Website by Eyefinity
  • Home
  • Our Practice
  • Our Services
  • Location
  • Eye Care Articles
  • Promotions
  • Patient Forms