4401 Galleria Oaks Drive
Texarkana, Texas 75503
Phone: (903)-838-9063
Fax: (903)-838-9074
Vision Source of Texarkana

New Patient Forms

We would like to welcome you to our practice and thank you for taking the time to look over our website! To save you time the forms below are available for you to print out and complete prior to your appointment. Please bring your insurance card(s) to your appointment as well. On the office policy form there is a list of insurance companies we are in network with for your review.

If you have any questions please contact one of our optometric assistants at 903-838-9063.

- Medical History Questionnaire PDF Acrobat PDF

- Financial Assignment and Agreement PDF Acrobat PDF

- Patient Authorization to Disclose Protected Health Information PDF Acrobat PDF

- Patient Consent & Acknowledgement of Receipt of Privacy Notice PDF Acrobat PDF

- Patient Registration Form PDF Acrobat PDF

Little girl with glasses

Children's Glasses

We have a large selection of children's frames that your child will love. Stop by today and we will help you find the right pair of glasses for your child.

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Eye Care Resources

You may be interested in one of the following related links.

Educational Video