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Submit Exam Registration

At Dr. Dennis Karambelas & Associates we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment. You can decide if you would like to Fax or E-Mail your complete forms.

  • You will need AdobeReader® to download and complete the forms. Download the Free AdobeReader®
  • Download the required form(s). Fill out the form(s) and complete the required information. Download & Print Form

    You may decide to either Email or Fax your completed forms.

  • Email completed form(s) to [email protected]
  • Fax printed and completed form(s) to our office or bring them with you to your appointment.

New Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals you have regarding your eye health or vision on the form.