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Welcome form Mobile App

The Welcome Form digital application is a must have for workers in the eye care industry. It allows users to instantly capture and record pertinent patient information such as; Date of Last Eye Exam, Reason for Visit, Glasses, Contacts, Brands, Comfortability, Medications and Drug Allergies. Furthermore this mobile app includes important insurance information and has a digital signature field to insure the reliability of the data gathered.

For more popular optometrists forms, come visit our optometrists forms category page!

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Welcome form Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Name:

  • Ico textbox

    Preferred Name:

  • Ico date

    Date of Last Eye Exam:

  • Ico multiline

    Reason for today's visit:

  • Ico statictext

    Please Tell Us About Your Eyes

  • Ico dropdown

    I currently wear glasses:

  • Ico multiline

    How Often/When?

  • Ico dropdown

    I currently wear contacts:

  • Ico multiline

    How Often/When?

  • Ico textbox

    Current brand of contacts:

  • Ico dropdown

    Are you currently comfortable in your contacts?

  • Ico textbox

    When do you typically switch to a new pair of contacts?

  • Ico dropdown

    If you don’t wear contact lenses, would you be interested in wearing them part-time?

  • Ico multiline

    Please list all current medications (prescription and over-the-counter) If you prefer, you can pr...

  • Ico multiline

    Please list all Drug allergies:

  • Ico statictext

    Most insurance policies pay only a portion of your total charges.

  • Ico signature

    Patient Signature:

  • Ico date

    Date:

  • ...and More!

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