Patient Forms

What to

Expect

When you visit our office, you will be warmly welcomed and we can answer any questions you may have about completing the paperwork so that Pupila Family Eye & Ear Care may see you. Our team will work together to evaluate your eyes and provide relevant eye care treatment information, review your vision benefits and payment options, fit you for glasses or contact lenses, and focus on exceeding all of your expectations. If at any time you have questions about the process or your specific health information, please ask.

Schedule Today

Access Our Patient Portal

Stay connected to your eye care anytime with our online patient portal. View your appointments, prescription information, and bills, or update your personal info from anywhere. Easy access helps you and your doctor communicate more effectively for a better care experience.

Patient Portal

Our Patient

Forms

At Pupila Family Eye & Ear Care, you can complete your patient forms online from the comfort of your home or office. Simply download the necessary forms, fill in the required information, and either email, fax, or bring them with you to your appointment. If you do not already have Adobe Reader® installed, you can download it to view and complete your forms.

Patient Welcome Form

English Form

Spanish Form

Child Welcome Form

English Form

Spanish Form

Allergy Skin Testing Consent Form

English Form

Spanish Form

Amniotic Membrane Consent Form

English Form

Spanish Form

Rinsada Treatment Consent Form

English Form

Punctal Plug Consent Form

English Form

Radio Frequency Consent Form

English Form

Intensed Pulsed Light (IPL) Consent Form

English Form

Phlebotomy and the Development of Platelet-Rich Plasma Consent Form

English Form

Telehealth Consent form

English Form

Spanish Form

Epioxa Consent Form

English Form

Records Release Form

English Form

Please Note: There will be a $50 cancellation fee, for the last minute cancelations and no shows. If you need to cancel or reschedule your appointment, it must be done a minimum of 24 hours in advance. No future appointments will be made until the fee is paid. Thank you!

What to

Expect

Access Our Patient Portal

Our Patient

Forms

See clearer, hear better, live healthier.

Energy Corridor

Lantern Lane

Pasadena

Sealy

New Caney