Arizona's Vision in Phoenix, Arizona - Patient Registration - Dr. Mark Page





					Arizona's Vision is always happy to accept new patients and appreciates the many referrals from our current ones. We accept many types of insurance with the Vision Service Plan (VSP) coverage being the most common coverage. For new and returning patients, we ask that you complete a medical history questionnaire to help the doctor accurately diagnose your condition. If you'd like to save some time, this form may be downloaded below and completed before your appointment !

	FOR NEW AND RETURNING PATIENTS

	If you are a new patient, or a returning patient with outdated address, insurance, or medical information, or have a child who is a patient, you may wish to download one of the forms below, complete the questions before your arrival, and bring the completed form to your appointment.

		Adult Patient Registration.pdf (230K)
		Child Patient Registration.pdf (203K)

ARIZONA'S VISION EVALUATION FORM

If you didn't get a chance to fill out an evaluation card during your visit, we'd like to hear from you.
Your comments help us make continuous improvements in the quality of your eye care. Thank You!

	YES	NO
Was our staff courteous and helpful?
Were you seen in a timely manner?
Was your examination thorough?
Were you satisfied with the explanation of your visual conditions and treatment options?
If we fit you with contact lenses or glasses, did our service and quality meet your expectations?
Will you refer others to our office for their eye care?
Do you plan on returning to our office for your future eye care needs?
How would you rate your overall satisfaction with our office?
Do you have any comments or suggestions?


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