Patient Center

Online Forms

Speed up your visit by completing the necessary form(s) below. For your convenience, you can either fill the form(s) out online or download and print the form(s) and bring it with you to your appointment.

Please fill out ALL the forms.

Patient History Form - Submit Online | Download & Print

Patient Insurance Information - Submit Online | Download & Print

Patient Payment Guideline - Submit Online | Download & Print

HIPAA Agreement - Submit Online | Download & Print

At Dr. Todd Wild, OD, we believe in continual improvement of our services. Please take a few moments and share your experience with our office. We appreciate your feedback!

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We are open for normal business hours and are seeing patients for all types of vision exams. We are following all COVID-19 guidelines, including sanitizing, wearing face masks and practicing social distancing.