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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