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Online Forms


At Akers Eyecare Center, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • 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.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

New 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 you have regarding your eye health or vision.

Download & Print Form

Informed Consent for Care Form

Download & Print Form


Akers Eyecare Center
3635 E. Inverness Ave, Suite 105
Mesa, AZ 85206
Phone: 480-210-1015
Office Hours

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