Great Lakes Vision Rehabilitation at Excel Neuro-Optometric Clinic
Traumatic and Acquired Brain Injury ∙ Learning Disabilities ∙ Autism ∙ Infant and Visual Development ∙ Neuro-Degenerative Diseases ∙ Visually Evoked Potential ∙ Visual Information Processing Testing ∙ Kinetic Color Visual Field ∙ Optometric Phototherapy
48189 Van Dyke Ave, Shelby Township, MI 48317
Phone: (586) 731-9725
Fax: (586) 488-0006
New Patient Forms
To reduce your wait time in our lobby we ask that you complete your new patient paperwork before your appointment. Each new patient must complete the Questionnaire, HIPPA Policy, Photo Consent, and No Show Policy forms.
The paperwork has been formatted to a fillable PDF. To access the forms please click the links below. Once the forms are completed you may print them off and bring them to your appointment or you can save them to your computer and email them to our patient care coordinator at patientcare@excelinst.com. Please note that some of the forms require a signature, if needed you may sign the forms in the office.
If you have any questions or concerns please contact our office,
We appreciate your cooperation!
New Patient Questionnaires
(18+ Years Old)
Office Policies
(Birth to 18 Years Old)