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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!

Health Care & Social Services mobile forms and apps for your team

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Take a Tour

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.

Name:
Preferred Name:
Date of Last Eye Exam:
Reason for today's visit:
Please Tell Us About Your Eyes
I currently wear glasses:
How Often/When?
I currently wear contacts:
How Often/When?
Current brand of contacts:
Are you currently comfortable in your contacts?
When do you typically switch to a new pair of contacts?
If you don’t wear contact lenses, would you be interested in wearing them part-time?
Please list all current medications (prescription and over-the-counter) If you prefer, you can pr...
Please list all Drug allergies:
Most insurance policies pay only a portion of your total charges.
Patient Signature:
Date:
...and More!