Online Forms

At Total Vision of Port Orange, 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.
  • 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 on the form.

Download & Print Form

For your convenience, we have provided forms to download & complete before your appointment:

New Patient Welcome Letter

New Patient Welcome Form

Records Release Form

HIPPA Form

Forms for after your visit:

Patient Questionnaire

Forms for outside referral:

Referral Pad


Download the Free AdobeReader®

Contact Us

We look forward to hearing from you.

Locations

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Hours of Operation

Our Regular Schedule

PORT ORANGE Office

Monday:

9:00 am-5:30 pm

Tuesday:

8:30 am-5:30 pm

Wednesday:

8:30 am-5:30 pm

Thursday:

8:30 am-6:00 pm

Friday:

8:30 am-12:00 pm

Saturday:

Closed

Sunday:

Closed