Online Forms

At Dr. Blacks' office, we value your time. In an effort to save you time in our office, you can submit your medical history form online or download and complete it and bring it to your appointment. 

Patient Health History Form - Submit Online


Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

  • You will need AdobeReader® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information and bring them with you to your appointment.

Patient Health History Form - Download & Print Form


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Exclusive Offer

Buy 1 complete pair of glasses (frame and lenses) and receive a 30% discount on a second pair that same day.

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Hours of Operation

Our Regular Schedule

Monday:

8:00am

5:00pm

Tuesday:

8:00am

6:00pm

Wednesday:

8:00am

5:00pm

Thursday:

8:00am

4:00pm

Friday:

8:00am

5:00pm

Saturday:

Closed

Sunday:

Closed

Location

Find us on the map

Testimonials

Reviews From Our Satisfied Patients

  • "I was very impressed with Dr. Kayla Black. I went there for the 1st time and she was very thorough and went above and beyond. Michelle was very friendly, helpful, and went over insurance details. I highly recommend! Thanks to Cindy Ewing for the referral."
    Rachelle Randle Christian
  • "As always very caring and respectful, I would recommend to anyone even though I don't have insurance to cover the cost well worth it and 20% discount for cash customers."
    Chris Wence

Featured Articles

Read up on informative topics

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  • Frequently Asked Questions

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  • Pediatric Ophthlamology

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  • Allergies

    Caused by the same irritants as hay fever, runny nose, coughing, and sneezing, eye allergies commonly affect those who suffer from other allergy symptoms. Not only do eye allergies cause discomfort, but they can also interfere with daily activities. Eye Allergy Causes Medically referred to as allergic ...

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  • Learning-Related Vision Problems

    Learning disabilities may include dyslexia, math disorder, writing disorder, auditory processing deficits, or visual processing deficits. Although each child with a learning disability is unique, many also have associated visual problems. Addressing these vision disorders may alleviate some symptoms ...

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  • UV Radiation and Your Eyes

    Optometry warnings about the damaging effects of ultraviolet radiation on our eyes have not yet reached the degree of public awareness of that of skin damage. Yet, the sun can be just as damaging upon our eyes with unprotected exposure. Short-term exposure to very bright sunlight can result in a type ...

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  • How To Protect Your Eyes While Wearing Halloween-Themed Contact Lenses

    Spooky novelty contact lenses can make your Halloween costume even scarier, but are they safe? ...

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  • Fuchs' Corneal Dystrophy

    Fuchs' dystrophy (pronounced fooks DIS-truh-fee) is an eye disease characterized by degenerative changes to the cornea’s innermost layer of cells. The cause for Fuchs' dystrophy is not fully understood. If your mother or father has the disease, then there is roughly a 50 percent chance that you will ...

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  • Age-Related Macular Degeneration

    One of the leading causes of vision loss in people who are age 50 or older is age-related macular degeneration (AMD). This common eye condition leads to damage of a small spot near the center of the retina called the macula. The macula provides us with the ability to clearly see objects that are straight ...

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  • Diabetic Eye Diseases

    Diabetes is a condition that involves high blood sugar (glucose) levels. This can affect many parts of the body, including the eyes. One of the most common diabetic eye diseases is diabetic retinopathy, which is also a leading cause of blindness in American adults. Diabetic Retinopathy Diabetic retinopathy ...

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