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Online Forms

At Primary Vision Care, 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. Click here to download.
  • 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

HIPAA and Dilation

Print Insurance Benefits

Print Retinal Health Screening


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Our Locations

Newark PVC - (740) 366-7341 Lancaster PVC - (740) 654-9909 Mt. Vernon PVC - (740) 393-6010

Lancaster PVC - (740) 654-9909

Mount Vernon PVC - (740) 393-6010

Location Hours

Newark Office

Monday:

10:00 am-7:00 pm

Tuesday:

9:00 am-6:00 pm

Wednesday:

9:00 am-5:00 pm

Thursday:

9:00 am-5:00 pm

Friday:

9:00 am-4:00 pm

Saturday:

Closed

Sunday:

Closed

Lancaster Office

Monday:

10:00 am-7:00 pm

Tuesday:

9:00 am-6:00 pm

Wednesday:

9:00 am-5:00 pm

Thursday:

9:00 am-5:00 pm

Friday:

9:00 am-4:00 pm

Saturday:

Closed

Sunday:

Closed

Mount Vernon (formerly York EyeCare Associates)

Monday:

10:00 am-7:00 pm

Tuesday:

9:00 am-6:00 pm

Wednesday:

9:00 am-5:00 pm

Thursday:

9:00 am-5:00 pm

Friday:

9:00 am-4:00 pm

Saturday:

Closed

Sunday:

Closed