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Ada Vision Center Downtown 1926 W. State Street, Boise, ID 83702

Ada Vision Center East 230 W Mallard Drive, Suite A Boise, ID 83706

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Patient Registration Form

  • Personal Information

  • Please take a few minutes to complete this Patient Welcome Form before you visit our office for the first time. Once you fill in the information, click on the "Submit" button to e-mail it to our office or bring a copy with you to your next appointment.
  • Date Format: MM slash DD slash YYYY
  • Primary Care Physician

  • Referring Physician

  • Health History

  • Date Format: MM slash DD slash YYYY
  • Eye History

  • General Health Condition

  • Family History

  • Spectacle Lens History

  • Contact Lens History

  • Please rate the following on a scale of 1-10 with 1 being POOR and 10 being EXCELLENT.

  • Lens Comfort
  • Distance Vision
  • Lens Comfort
  • Complete Your Social History

  • Thank you for completing the Welcome Form information, we will be able to provide you with the best evaluation of your health using this information. We look forward to seeing you soon!