SOUTH SHORE EYECARE ASSOCIATES (718) 979-2020
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    • Sun Protection For Your Eyes
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    • Glaucoma Awareness
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    • Myopia Management
    • Presbyopia Management
    • Sports Protection
    • Back to school eye exam!
    • Healthy Aging for the Eyes!

Patient Forms

Filling out these forms now can save you roughly 20 minutes once you arrive to our office!  

The two forms below will expedite the registration for your appointment at our office. Please follow the link for secure online registration AND download the PDF form.  Bring the SIGNED PDF form into the office for your appointment.  Please complete both forms. 


Form 1:  FILL OUT ONLINE

 CLICK HERE to fill out your Information and History 

Form 2:  PRINT  AND BRING WITH YOU
medical_ins._info-hipaa.doc
File Size: 45 kb
File Type: doc
Download File


Information for Contact Lens wearers
File Size: 71 kb
File Type: pdf
Download File


OPTIONAL form below to determine if you or your child may have a vision related learning problem.
academic_and_re-evaluation_questionnairre.docx
File Size: 22 kb
File Type: docx
Download File


OPTIONAL form below to help the opticians guide you to the best choice of eyewear for your needs.
Lifestyle Questionnaire for Glasses Selection
File Size: 76 kb
File Type: pdf
Download File

Practice Logo
Contact Us
South Shore Eyecare Associates
50 Cooper Avenue

Dongan Hills
Staten Island, NY 10305
Phone: 718-979-2020
Fax: 718-979-2141
E-mail: info@eyesoncooper.com
Hours:
Monday 10:00 am - 5:45 pm
Tuesday 10:00 am-5:45 pm  
Wednesday 10:00 am-5:45 pm
Thursday 10:00 am-5:45 pm

Friday 10:00 am - 5:45 pm
Saturday 8:00 am- 2:45 pm
Sunday Closed

​Notice of Privacy Practices
Website by Eyefinity
  • Home
  • COVID-19 Information
  • Our Staff
  • Request Appointment
    • Patient Forms
    • Insurances
    • Privacy Notice
  • Online Store
  • Our Services
    • Vision Therapy >
      • VT home activities
      • Vision Links
      • Testimonials
    • Eyeglasses
    • Contact Lenses
    • Myopia Management
    • Ocular Disease
    • Low VIsion
  • Eye Care
    • Eye Care Articles
    • FAQ
    • In the News...
  • South Shore Eyecare Newsletter
    • Sun Protection For Your Eyes
    • Nutrition and the Eye
    • The eye and the heart
    • Glaucoma Awareness
    • Spring Time Red Eye
    • Myopia Management
    • Presbyopia Management
    • Sports Protection
    • Back to school eye exam!
    • Healthy Aging for the Eyes!