Jeffrey Liegner, MD
1 Wilson Drive, Sparta, NJ 07871 (973) 579-2020

New Patient Forms

Eye Care Northwest > Patient Info > New Patient Forms
New Patient Forms | Eye Care Northwest

Eye Care Northwest Team Members


Simplify Your Visit

Paperwork is a necessary evil in the practice of medicine today.  We want to ease your time with us so we can spend more time seeing you. Click on the links below for PDF downloads of select new patient forms for those interested in LASIK or Lens Replacement (Cataract) Surgery. If you have any questions, please call us.

If You’re New To Our Practice: Medical History Form


If You’re Interested In LASIK: LASIK Checklist and Patient History


If You’re Interested In Lens Replacement: LENS Checklist


If You’re Suffering From Dry Eye: SPEED Questionnaire


IF YOU’RE Interested in Looking Younger: COSMETIC Interest


If you’d love to share your experiencePublicity Release


If you’d like us to have your prior eye care records: Medical Records Release