Our mission is to give you personalized eye care with the use of latest technology to enhance your vision. When you put your trust COUNCIL OPTOMETRIC CENTER of Erie, you can feel confident that youíre dealing with experts specializing in vision care.

We offer unique visual solutions to improve our patientís quality of life. At COUNCIL OPTOMETRIC CENTER our goal is to make each of your visits a very pleasant experience.

Our reputation for outstanding vision care has been built on our policy of exceeding our patientsí expectations.


PLEASE SELECT ONE:

  • PATIENT REGISTRATION FORM

  • MANTA

  • EYEGLASS GUIDE



Patient Registration Form

PERSONAL INFORMATION










 







 




PLEASE COMPLETE THE FOLLOWING QUESTIONS:

Do you have visual difficulty when driving?

Yes
No

Do you have problems with night vision?

Yes
No

Do you currently wear contact lenses?

Yes
No

How long?

Do you currently wear glasses?

Yes
No

How long?

Do you drink alcohol?

Yes
No

Do you smoke?

Yes
No

Do you use any other substances?

Yes
No
 



PLEASE COMPLETE THE FOLLOWING QUESTIONS:


DESCRIPTION


 


 


 


 


 


 


 


 


 


 


 


 


 


 








Thank you.




Manta




Eye Glass Guide

EyeGlass Guide





 

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