Club View Vision Center, Inc.
Give us a call:
419-562-0744
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Patient Forms

Medical History Form

​Since the new changes to Health Care in the recent past, we need to have a current Medical History Questionnaire on file for all patients who come in for an exam. You can print this up here by clicking on Medical History Form and fill it out at your convenience to bring into the office with you or you can fill it out online by signing in above and it will be automatically sent to us.
Club View Vision Center, Inc.
1650 E. Mansfield St.
PO Box 744
Bucyrus, OH 44820
Phone: (419) 562-0744
Fax: (419) 562-3861
Hours:
Mon - 8:00 AM - 6:30 PM

Tue, Wed, Thu - 8:00 AM - 5:00 PM
Fri - 8:00 AM - 4:00 PM

Sat - By Appointment Only
Notice of Privacy Practices
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