Downloadable patient forms that you can print and fill out before your next visit to Hertneky Vision Source in Brush.
For your convenience, we have created the following pages to provide you with a list of the insurance carriers we accept at our Brush optometric office, as well several downloadable forms to save you time at your next appointment.
- New Patient Form [PDF]
- Fillable New Patient Form [DOCX]
- Medication Reconciliation Authorization [PDF]
- Resolution of Concerns [DOCX]
- Privacy Practices [PDF] (only print if you want a copy for yourself)
- Acknowledgement of Privacy Practices [PDF]