New Patient Form

New Patient Form


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Digital Retinal Screening

The health of your eyes is the most important component of your eye exam. At Carolina Eye Care on Merrimon, we recommend Digital Retinal Screening in which a high-resolution digital photograph is taken of the back/interior portion of your eye called the retina. This is a screening and will not be covered by insurance.

The cost for this service is $25. Perform this service?


Have you ever been diagnosed or treated for the following health problems?

Are You having any of the following Vision Concerns?

Allergies


Do you wear


Are you satisfied with the vision and comfort of your contact lenses?


Is there a family medical history of any of the following?

Check all that apply
Please list relationship (Mother, Father….)

Have you ever been diagnosed or treated for the following Eye Conditions?


Medications

Contact Info

  • Address:
    825 Merrimon Ave
    Asheville, NC 28804
    Get Directions
  • Phone:
    (828) 236-0099
  • Fax:
    (828) 236-1236
Connect:
admin none 8:30 am - 5:30 pm 8:30 am - 5:30 pm 8:30 am - 5:30 pm 8:30 am - 5:30 pm 8:30 am - 5:30 pm By Appointment Closed