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Patient Registration Form

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • *Please read the following and check the boxes below *

  • Date Format: MM slash DD slash YYYY
  • Eye History

  • Medical History

    (If applicable)
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We are happy to announce that we are officially opened.

Please click here to read our new office protocols

Of course if you need to contact the office about any emergency matters during this time please email us at reception@ancasterfamilyeyecare.com with details and we will get back to you as soon as possible. These emergencies would include sudden changes to vision or ocular injuries. We will also be checking our voicemails on a regular basis.

Lastly, to order contact lenses and other products please click here

Thank you for your understanding, we are looking forward to seeing you soon.