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Online Forms

At American Eyecare, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

Please fill out the following forms prior to your visit:

Application For Employment

Donation Request Form

Notice of Privacy Practices

Patient Information



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Location

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Hours of Operaton

Our Regular Schedule

Burlington Office

Monday - Friday:

9:00 am - 6:00 pm

Saturday:

9:00 am - 1:00 pm

Sunday:

Closed

Fairfield Office

Monday - Friday:

9:00 am - 5:00 pm

Saturday, Sunday:

Closed

Fort Madison Office

Monday - Friday:

9:00 am - 6:00 pm

Saturday:

9:00 am - 1:00 pm

Sunday:

Closed

Keokuk

Monday - Friday:

9:00 am - 6:00 pm

Saturday:

9:00 am - 1:00 pm

Sunday:

Closed