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New Patient Forms
Welcome to Insight Eye Center. New patients can download the patient forms below, complete them and bring them to their appointment, or fill them out online ahead of time. This page also lists what to bring so your first visit with Dr. Rom in Mentor goes smoothly.
Which forms do I need before my first visit?
New patients complete one packet — patient information, insurance and consent, medical history and medications. Download it below, print it, fill it out and bring it to your appointment, or complete it online before you come. Either way, arriving with the paperwork done means you spend your visit with Dr. Rom rather than with a clipboard.
- New patient forms (PDF)Patient information, insurance and consent, medical history and medications. Print and complete before your visit.
- Complete the forms onlineThe same intake as a four-step online form, submitted directly to the office.
What should I bring to my appointment?
Bring your completed forms, your insurance card and a photo ID, a list of the medications and supplements you take, your current glasses, and — if you wear them — your contact lenses and their prescription. If your pupils may be dilated, bring sunglasses and consider a driver, since near vision is blurry for a few hours afterward.
Paperwork
Completed new patient forms (or your online confirmation), insurance card, photo ID, and any referral from your optometrist or physician.
Medical details
A list of medications and supplements, your eye history, and the names of your primary care physician and any eye doctor you have seen.
Eyewear and a driver
Your glasses and contact lenses. A cataract evaluation includes dilation; bring sunglasses and, if you are unsure about driving while dilated, a driver.
Common questions from new patients
Short answers to the questions patients ask most often. For anything specific to your eyes, ask Dr. Rom at your visit or call the office at (440) 286-1188.
Do I have to print the forms?
No. You can complete the intake online before your visit, or fill out paper forms at the front desk if you arrive about 15 minutes early.
How long does a first visit take?
Plan on about an hour for a comprehensive exam, longer for a cataract evaluation, which includes dilation and lens measurements.
Will my eyes be dilated?
Usually, for a comprehensive or cataract evaluation. Dilation blurs near vision and increases light sensitivity for a few hours — bring sunglasses and consider a driver.
Which insurance do you accept?
Medicare and most major medical plans. Call (440) 286-1188 with your plan details and the staff will confirm before your visit.
Not scheduled yet?
Request an appointment and the office will call to find a time. Then complete the forms at your convenience.
