Infant/Toddler Online Questionnaire

Please carefully complete our questionnaire. The information supplied will allow for more efficient use of time and will permit us to make a complete optometric evaluation of your visual system related to your specific needs.

To Our Patients,

There will be some important safety changes that you need to know. Please read the following carefully:

1.  Face masks MUST BE WORN by all patients over the age of two.

2.  Maximum of two family members per office visit.

3. Appointments will be necessary for pick-ups, repairs or adjustments.  The office is not taking walk ins at this time.  Thank you for understanding.

4. Special hours will be available for 65y/o or older and high risk patients.

5. Our waiting room has been redesigned for proper social distancing. 

6. Office forms will be emailed prior to your appointment. Please complete the forms at least 2 days before your exam or sooner.  Failure to do so may result in the cancellation of your appointment.   

7. Please call the office or ring the door bell for entry. 

8. Temperatures will be taken at the door.

9. Please cancel your appointment if you have/had any of the following symptoms within the last two weeks: 

  • Cough
  • Shortness of breath or difficulty breathing
  • Fever
  • Chills
  • Muscle pain
  • Sore throat
  • New loss of taste or smell
  • Have been diagnosed with COVID-19

In light of the pandemic, our goal at Family Vision Care Optometry is to provide vision care services in a safe environment. We want to minimize close proximity with testing that is part of our comprehensive eye exam. There are some ways to scale back the testing and these are being implemented.

Dilation, for example, does require some close contact. Instead we are offering to do photos of the inside portion the eye to evaluate the internal health of the eye. This service does not require the close contact. There is a charge of $35.00 for a set of photos.

Please let us know by checking one of the options at the end of your questionnaire.

___   Yes, I would like to have the photos taken of the internal part of my eye and understand there is a charge of $35.00.

___   No, I do not want to have the photos taken and understand that dilation may be necessary.

During this time we are taking all the necessary precautions for the safety of our patients and our staff.  We want everyone to be healthy, happy and enjoy great vision. Thank you for your attention to all of these issues.


24 Hour Cancellation Policy

We realize that emergencies and other scheduling conflicts arise and are sometimes unavoidable. However, advance notice allows us to fulfill other patient’s scheduling needs and keeps the clinic operating at is most efficient level. Due to our 60-minute exams missed appointments are a significant inconvenience to your doctor, the clinic and other patients.

This policy is in place out of respect for our doctors and our clients. Cancellations with less than 24 hours notice are difficult to fill. By giving last minute notice or no notice at all, you prevent someone else from being able to schedule into that time slot, and leave a 60-minute hole in the doctor’s schedule.

  • Please provide our office with 24-hour notice to change or cancel an appointment. Patients who do not attend a scheduled appointment or do not provide 24-hour notice to change a scheduled appointment will be responsible for a $25.00 service chargeThis charge cannot be billed to insurance and must be paid before scheduling your next appointment.
  • We reserve your one-hour appointment time just for you. We do not double-book our patients so that we may provide optimum treatment outcomes for all our patients. 24-hour notice allows us to offer that time to a wait-listed patient.

NOTE: You will never be charged for a cancellation if it is made more than 24 hours in advance of your scheduled appointment time.

Thank you for providing our office and our patients with this courtesy.



Dr. Garbus, and the Family Vision Care Staff


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