Name: Athens Eye Care Center PC
Address: 22894 US HIGHWAY 72, Athens, AL, 35613, US
Telephone: (256) 232-2409
Price range: $000 - $300

256-232-2409
22894 US HIGHWAY 72
Athens, AL 35613

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Hours
Monday: 8:30 AM - 5:00 PM

Tuesday: 8:00 AM - 5:00 PM

Wednesday: 8:00 AM - 5:00 PM

Thursday: 8:00 AM - 5:00 PM

Friday: 8:00 AM - 12:00 PM

Saturday: Closed

Sunday: Closed
Holiday Hours May Vary

	Yes	No
Bloodshot Eyes
Blurred Vision - Distance
Blurred Vision - Near
Burning Eyes
Cataracts
Color Vision, Poor
Crossed Eyes
Discharge from Eyes
Dizzy/Fainting Spells
Double Vision
Dry Eyes
Eye Infection
Eye Injury

	Yes	No
Floaters or Spots
Glaucoma
Itching Eyes
Light Sensitive
Loss of Vision
Headaches
Night Vision, Poor
Seeing Halos
Seeing Flashes
Twitching Eyelid
Vision Poor
Watering Eyes
Red Eyes

	Yes	No
Fever, Weight Loss/Gain
Cancer

	Yes	No
Skin Disease/Skin Cancer
Breast Disease
Acne Rosacea

	Yes	No
Diarrhea
Constipation
Crohn's Disease
Irritable Bowel
Acid Reflux/GERD

Patient Registration Form

Paperwork Submission

Step 1 of 2

Patient Information:

Guarantor Information:

Insurance Information

Eye Health History

Medical History

Privacy Policy

	Yes	No
Headaches
Migraines
Seizures/Epilepsy

	Yes	No
Rheumatoid Arthritis
Osteoarthritis
Lupus
Fibromyalgia
Osteoporosis

	Yes	No
Thyroid Problems
Diabetes

	Yes	No
Asthma
Emphysema
COPD