Online Forms

At Burcham Eyecare Center, 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 will need AdobeReader® to download and complete the forms.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your 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 your have regarding your eye health or vision on the form.

Download & Print Form


Download the Free AdobeReader®

Contact Us

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You can also call us at (303) 340-4600. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Attention New and
 Returning Patients!

You can save time by completing your 
new patient forms ahead of time.

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