Citywide Eye Care Logo - Eye Doctor in Great Neck NY
(516) 226-1861Contact UsBook AppointmentBook

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Citywide Eye Care logo
107 Middle Neck Rd, Great Neck, NY 11021
Call (516) 226-1861
Text (516) 266-9398
citywideeye@gmail.com
Mon
Closed
Tue
9:30 AM - 3 PM
Wed
Closed
Thu
9:30 AM - 6 PM
Fri
Closed
Sat
9:30 AM - 3 PM
Sun
Closed

Quick Links

  • Home
  • Our Story
  • Meet Dr. Zhu-Tam
  • Insurance
  • FAQ
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  • Patient Forms
  • Doctor Referral

Services

  • Myopia Management
  • Ortho-K
  • MiSight Lenses
  • Atropine Drops
  • Stellest Lenses
  • Vision Therapy
  • Therapy Program
  • Neuro-Visual Rehab
  • Dry Eye Treatment
  • RF Treatment
  • IPL Treatment

Eye Exams

  • Comprehensive Eye Exam
  • Refraction Exam
  • Contact Lens Exam
  • Pediatric Eye Exam
  • Adult Eye Exam
  • Emergency Eye Exam
  • Special Needs Eye Exam

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Patient Resources

Patient Registration Forms

Download and complete these forms before your appointment to save time at check-in

Why Complete Forms in Advance?

Completing your patient forms before your visit helps us provide you with more efficient care. By having your information in advance, we can:
  • Reduce your wait time during check-in
  • Prepare for your specific health needs before your arrival
  • Ensure your medical records are up-to-date
  • Verify your insurance information in advance

Form Instructions

Pediatric (Under 18)

  • Demographic
  • Pediatric Medical
  • Acknowledgment

Adult (18+)

  • Demographic
  • Adult Medical
  • Acknowledgment

All patients should also review: Notice of Privacy Practices, Refund Policy, and Consent to Photograph.

Please Note:

Medical insurance covers medical eye exams such as dry eyes, red eyes, glaucoma testing, diabetic and hypertensive retinopathy exams. Vision insurance only covers routine exams such as glasses prescription (refraction).

Required Patient Forms

Demographic Form

Basic patient information and contact details

Download

Pediatric Medical Form

Medical history for patients under 18 years of age

Download

Adult Medical Form

Medical history for patients 18 years and older

Download

Acknowledgment Form

Acknowledgment of receipt of privacy practices

Download

Notice of Privacy Practices

Information about how your medical information may be used

Download

Refund Policy

Our policy regarding refunds for services and products

Download

Consent to Photograph

Permission to take photographs for medical documentation

Download

Frequently Asked Questions

For adults (18+ years), please fill out the Demographic Form, Adult Medical Form, and Acknowledgment Form. For children (under 18 years), please fill out the Demographic Form, Pediatric Medical Form, and Acknowledgment Form.

Yes, you can complete the forms at our office. However, we recommend downloading and filling them out beforehand to reduce your waiting time during check-in.

We recommend completing and submitting your forms at least 48 hours before your scheduled appointment for efficient processing.

No, returning patients only need to update their information if there have been changes to their contact information, insurance, or medical history since their last visit.

Book your appointment

Call (516) 226-1861, text (516) 266-9398, or request a time online.
Book Appointment
Call (516) 226-1861