Advantage Eyecare
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Secure Online Forms


If you'd like to email your patient forms before your appointment, please use the forms below.

WELCOME FORMS
​

New Patient Welcome Form 

 Low Vision Welcome  Form  (For low Vision use only)

Paper Patient Forms

If you'd rather use paper forms, please print out and fill out the forms below and bring them with you to your appointment.
Low Vision Patient Welcome Form
File Size: 1658 kb
File Type: pdf
Download File

New Patient Welcome Form
File Size: 2237 kb
File Type: pdf
Download File

HIPPA form
File Size: 53 kb
File Type: pdf
Download File

Contact Us:
Charles H. Rutan, O.D.
224 Elm St.
Clinton, IN 47842

Phone: 765-832-3292
Toll Free: 877-377-8826
Fax: 765-832-9730

Office Hours:
Monday - Friday    
9:00 am - 5:00 pm

 




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Website by Eyefinity
  • Home
  • Our Practice
  • Our Services
    • Low Vision
    • Promotions
    • Information Websites >
      • Eye Specialty Services in Clinton
  • Schedule Appointment
  • Patient Forms
  • Order Contacts & Vitamins
    • Order Vitamins
    • Order Contacts
  • Location