Skip to main content

Premier Vision Clinic, Dr. Jennifer DenHartog, Optometric Physician

Schedule An Appointment
Call 515-512-1444
Home » Contact Us » Patient Forms

Patient Forms

Complete or update the health history forms to provide the doctor with information needed for your exam.

New Patients:

Existing Patients:

If you wish to grant a family member access to your personal health information, including discussing billing information, please fill out this form and bring to your appointment:

We understand that life happens, and we want to be flexible to meet your scheduling needs. When you cancel less than 48 hours in advance or miss your appointment, it is likely we are unable to offer that appointment to another patient. Therefore, any late cancellation or missed appointment will be charged a $30 fee.

Premier Vision Clinic 482209 Save the date 3972 Homepage 1280×480 100 v3