Toufexis Family Eye Care
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Patient Forms


If you are new to the office or a returning patient, please read through the privacy policy for the most updated HIPPA information and the Insurance Questions forms for up to date information.
  • Privacy Policy
  • Insurance Questions

New Patient Form

If you are new to the office, please fill out the New Patient Form
Click Here

EVERY Patient New or Returning MUST fill out the COVID Health Questionnaire before coming in to the office.

Fill out the form below, your responses will be submitted directly to the office email. We will call you if we need to Reschedule your appointment.

Covid Health Questionnaire

    If you have been exposed to a communicable disease, you may spread the disease to the optometrist, optometrist staff or other patients in the practice. Therefore, prior to each appointment, we will be asking the following questions to reduce the chances of transmission:

I understand that if the answer to any of these questions is yes, I may be asked to reschedule my appointment.
Copyright © 2014 . 76 S Lexington Avenue, White Plains, NY 10606. 914-422-2686. toufexiseye@gmail.com
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  • Home
  • The Family
    • The Doctors
    • The Staff
    • In the Community
    • Testimonials
  • Insurance
  • Contact Lenses
  • Resources
    • Patient Forms >
      • Covid Health Questionnaire
      • New Patient Demographic Form
    • My Medical Records
    • Blue Light Exposure
    • Sports Eye Injury Prevention
    • Ocular Conditions
  • Products
    • Lenses