Patient forms

At DeBoer Eyecare, we offer patient forms online so you can complete them in the convenience of your own home or office. Fax or email us your completed forms or bring a printed copy to your visit.
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  • If you do not already have AdobeReader® installed on your computer, Click Here to download it now.

  • Download the necessary form(s), print it out and fill in the required information.

  • Fax or email us your completed form(s) or bring it with you to your appointment.


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Roya1234 none 9:00 AM - 6:00 PM 9:00 AM - 6:00 PM 9:00 AM - 6:00 PM 9:00 AM - 6:00 PM 8:00 AM - 5:00 PM 8:00 AM - 12:00 PM Closed optometrist https://www.google.com/search?q=609+N+Halleck+St.+%E2%80%8BDeMotte%2C+IN+46310+DE+BOER+FAMILY+EYECARE&sxsrf=ALeKk02hA2D_DDR5pVmwIoE1jr-IBqtDZQ%3A1618545264229&ei=cAp5YMvRDanWmAXX557QDw&oq=609+N+Halleck+St.+%E2%80%8BDeMotte%2C+IN+46310+DE+BOER+FAMILY+EYECARE&gs_lcp=Cgdnd3Mtd2l6EANQ8lVY41dgq1loAXAAeACAAZABiAHJApIBAzIuMZgBAKABAaABAqoBB2d3cy13aXrAAQE&sclient=gws-wiz&ved=0ahUKEwjLyZv87oHwAhUpK6YKHdezB_oQ4dUDCA4&uact=5#lrd=0x8812204b6b5195e3:0xac0150d52451fbc6,3,,, https://www.yelp.com/writeareview/biz/wbR3meGjXyyiHQK1tb7Vmg?return_url=%2Fbiz%2FwbR3meGjXyyiHQK1tb7Vmg&source=biz_details_war_button https://www.facebook.com/DeBoerFamilyEyecareDeMotte/reviews/?ref=page_internal https://www.google.com/maps/embed?pb=!1m14!1m8!1m3!1d12006.479910674887!2d-87.198339!3d41.208258!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x0%3A0xac0150d52451fbc6!2sDe%20Boer%20Family%20Eye%20Care!5e0!3m2!1sen!2sph!4v1618548639138!5m2!1sen!2sph https://g.page/de-boer-family-eye-care-demotte?share