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Patient Forms

Access our patient forms that you can fill out before your next visit to Restore Eye Care & Eye Gym in State College.

Our Forms

  • Privacy Notice [PDF]
  • Release of Information [PDF]
  • Signature on File [PDF]
  • Lifestyle Checklist Form [PDF]
  • Post Vision Therapy Questionnaire [PDF]
  • Electronic Media Consent Form [PDF]

Online Forms

  • Privacy Notice
  • Release of Information
  • Signature on File
  • Lifestyle Checklist Form
  • Post Vision Therapy Questionnaire
  • Electronic Media Consent Form

Online Form Packets

  • New Patient Forms
  • Vision Therapy Consultations
  • Established patients