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816-461-6880 H
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816-461-6880

Online Forms

At Independence Family Eye 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 below to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Bring your printed and completed form(s) with you to your office or fax them to the office before your appointment

New Patient Welcome Form – Required

Please complete this form and bring it to the office 20 minutes before your appointment time. Let us know what questions, concerns, you have at the check in.

Download & Print Form


HIPAA Form

You can print or read you HIPAA rights as a patient.

Download & Print Form


Download the Free AdobeReader®

Holiday Contest

Stop in our optical department and enter to win a pair of polarized sun glasses!No purchase necessary!Contest runs through December 11, 2017.Still have flex money to use? Prescription sunglasses, contact lenses and second pairs of glasses can be used towards your flex spending account.

Click Here to Order Contacts

Office Hours

DayMorningAfternoon
Monday9:00am5:00pm
Tuesday10:00am6:30pm
Wednesday10:00am5:00pm
Thursday9:00am5:00pm
Friday9:00am5:00pm
SaturdayClosedClosed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9:00am 10:00am 10:00am 9:00am 9:00am Closed Closed
5:00pm 6:30pm 5:00pm 5:00pm 5:00pm Closed Closed