Please print and fill out both forms and bring to your appointment with a list of you medications

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PATIENT FORMS
LALLY VISION CARE

816-524-1616
1
2
Please bring a list of all of your medications
and dosages.  Include prescription, over the
counter, vitamins, and supplements.  We can
attach this list to your patient forms and you
will not need to fill in all of the medications on
the form above.
In addition, please bring a photo ID
and any vision and/or medical
insurance cards with you to your
appointment.