Patient Registration Form
Please fill out and print this form and bring it with you to your appointment, as well as your insurance cards and picture ID.
Electronic Web Registration
DePoe Eye Clinic has gone paperless!! Please use this link to electronically submit your demographic, insurance and medical history information. Web registration will significantly reduce your wait time. Thank you for helping us better serve our patients.
Note: These files are in PDF format. If you do not have Adobe® Reader®, you can download it for free by clicking here or on the