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Located across from the Capitol Complex & State Museum

Call Our Eye Clinic: (717) 230-1722 Call Our Hearing Clinic: (717) 254-4849 Schedule Your Appointment Online
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Online Patient Registration Form – Vision

lock icon Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office. This form contains confidential information and is delivered to your doctor through a secure Internet connection.