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Call Us Today

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At Berk Eyecare Center, we value your time. In an effort to save you time in our office, please click the link below to complete your registration information online. This is a one time online registration request. If completing more than one patient's online registration information please leave the registration page and click back to the website to start a new patient registration; this will ensure that Berk Eye Care receives every completed registration. Should you have any questions, please contact our office.


Online 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.

Online Form


New Patient Health History Form

Please complete this form only if you cannot complete the online registration as it lets us know the history and current state of your health for your appointment. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

Download & Print Form


  • You will need AdobeReader® to download and complete the forms. Click Here to Download the Free AdobeReader®
  • Download the required form(s). Print out the form(s) and complete the required information.
  • You can email or fax your completed form(s) to our office or bring them with you to your appointment.

COLUMBUS OFFICE


Fax (614) 866-3581

GAHANNA OFFICE


Fax (614) 428-9856

Featured Services

Services
We strive to provide complete care for our patients. Learn more about all the services we provide.
Patient Registration
Our patient forms are available online so they can be completed in the convenience of your own home or office.