Cheyenne Vision Clinic

1200 East Pershing Blvd.

Cheyenne, Wy 82001

phone: 307.634.EYES (3937)

fax: 307.638.6451 

Email:

cheyennevisionclinic@gmail.com
Click above to go straight to 
the appointments section and find out what kind of appointment can help your youngster.
duck photo by Christopher Woo
bus photo by Kevin Dooley
road photo by Kevin Dooley
Time picture but Leland Francisco
newspaper picture by Kevin Dooley
Fill out our convenient computer accessible paperwork now! Just click the picture above.
Make an appointment Today! 307.634.EYES (3937)

24 hour on-call emergency eye injury care

Patient Information
brief information including the insurance information for the patient
PDF VERSION TO PRINT
Medical History 
The patient medical history as well as a brief family medical history.
PDF VERSION TO PRINT
Notice of Privacy Practices
A brief description on our policies that allow us to follow HIPPA guidelines. 
PDF VERSION TO PRINT
Patient Forms
Retinal Photography
A waiver and introduction to the option of retinal photography instead of dilation.
​PDF VERSION TO PRINT
Forms need to be completed upon arrival for your examination. We have listed them here for you because it can decrease your appointment time significantly if you have them filled out prior to your arrival. You can save even more time if you can email them to us prior to coming in!

Below are two different sets of forms. One set is computer accessible and is designed to be entirely paperless. All you have to do is fill it on in your version of Microsoft Word and email it back to us. Please be sure and do all FOUR.

To fill out the following form paper-less, is simple. It can only be opened in Microsoft Word, if there are any error/ warning alerts located under your tool bar you might have to enable editing.

When you get the alerts settled you should be able to click in any shaded-area to add your information. The boxes shaded in grey simply require a click to display the possible answers, and any little check boxes just need to be clicked to mark the box. 

See the tutorial video below

The versions listed below are Print accessible. For those of you, that would prefer to print their paperwork and bring it with them to their appointment or mail it to us prior to the arrival.
Microsoft, Encarta, MSN, and Windows are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries.
As soon as you complete any paperwork email it to us at:

Cheyennevisionclinic@gmail.com

Or bring it to us at:
 1200 East Pershing Blvd. Cheyenne WY

Save some TIME, 
             try the Hassel Free Option