New Patient Forms

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Have a question? We have answers.

(321) 499-3330

New Patient Forms

Please download the forms below and either:


  • Fill them out digitally using a PDF editor,or
  • Print them out and fill them in by hand.


Once completed, you can bring them to your appointment or email them to erick@libertyopticalusa.com.

Insurance & Payment Options

We accept most major vision insurance plans and offer flexible payment options to make eye care accessible for everyone.

Accepted Insurance:

  • VSP
  • EyeMed
  • Davis Vision
  • Most major medical insurance

Payment Options:

  • Cash and credit cards
  • CareCredit financing
  • HSA/FSA accepted
  • Payment plans available