WERNER EYES OF THE VALLEY
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REQUEST APPOINTMENT - WALNUTPORT
REQUEST APPOINTMENT - WIND GAP

Patient  Forms

NEW  PATIENTS:  Do  you  wear  glasses  or  contacts?  If  yes, please  bring  along any old boxes  or  old  glasses  that  you  may  have.  New patients are always dilated (or may instead opt for the highly recommended Optomap) for the first eye exam.  Thank  you!!
RETURNING PATIENTS:  Please fill out forms with any changes from previous years.  If you are looking for the online patient portal, click here!  We will perform pupil dilation (or you may opt for the Optomap) every year to best evaluate y​our eye health.
Please  remember to  bring  along  these  forms below, AND also bring your Medical  Insurance  card, Photo  ID  and an  updated  medication  list!
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New Patient Paperwork
File Size: 579 kb
File Type: pdf
Download File

Established Patient Paperwork
File Size: 338 kb
File Type: pdf
Download File


Email
File Size: 23 kb
File Type: pdf
Download File

Understanding Insurance
File Size: 30 kb
File Type: pdf
Download File

Contact Us (Walnutport Office)
Werner Eyes of the Valley at Walnutport
301 N Best Ave
Walnutport, PA 18088
Phone: 610-767-1555

Walnutport Office Hours
Mon   10am - 7pm
Tue     8am - 5pm
Wed    8am - 5pm
Thu     8am - 5pm
Fri       8am - 1pm
(Closed for Lunch: M - 2-3pm, T/W/Th- 12-1pm)
​


Contact Us (Wind Gap Office)
Werner Eyes of the Valley at Wind Gap
336 S Broadway
Wind Gap, PA 18091
Phone: 610-863-5665

Wind Gap Office Hours
Mon   10am - 7pm

Tue     8am - 5pm
Wed    8am - 5pm
Thu     8am - 5pm
Fri       9am - 1pm
(Closed for Lunch: M - 2-3pm, T/W/Th- 12-1pm)
​


Contact Us (Parkland Office)
Werner Eyes of the Valley at Parkland
4930 PA-873

Schnecksville, PA 18078
Phone: 610-799-2200

Parkland Office Hours
Mon   9am - 12pm

Tue     12pm - 5pm
Wed    Closed
Thu     9am - 5pm
Fri       9am - 1pm
​


Notice of Privacy Practices
  • Home
  • >> Schedule Exam
  • Our Services
    • Order Contact Lenses
    • Patient Portal
    • Patient Forms
    • Our Frame Selection
    • Optomap Option
    • Low Vision Services
    • Glaucoma Testing
    • Diabetic Eye Exams
    • Colored Contacts
  • Doctors & Staff
  • Promotions
  • Eye Care Articles
  • Locations