Patient Info Form

If you are scheduled for an appointment in our office, print and complete this form and bring it with you. Please be thorough, as this information is used by the doctor to manage your care, and by the bookkeeper to bill your insurance(s) appropriately and minimize any out of pocket expense.

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  • Our practice specialty lies in the treatment and management of degenerative corneal conditions like Keratoconus. Using our in-office laboratory and expertise, we are able to offer distinct advantages to the Keratoconic patient, which will translate to optimal visual acuity and comfort.

    Keratoconus Treatment

  • Are there any alternatives for correcting vision besides refractive surgery? What if we could non-surgically change corneal shape in a controlled manner while the patient sleeps, resulting in excellent visual acuity during waking hours without the use of glasses or daytime contact lenses? We can!

    Corneal Reshaping

    • The Corneal Reshaping program is a must for sports. Being a tri-athlete, I don’t have to worry about my goggles leaking and water getting on my contacts.

      - John R.
    • I always recommend the office to my family, friends and co-workers. If Dr. Rembleski and staff can custom fit contacts for me, they can custom fit most anyone for contacts.

      - Vicki P.
    • Thank you for your 15 years of fabulous service to my family and me! I love seeing all of you…Pam, Dr. R, Dr. L., Fred, etc. etc. (wonderful staff). You’re like family. Thanks again for your kindness!

      - Patty G.
    • Before I came to this office I had tried wearing soft lenses, but … the toric lenses would spin a bit with every blink, making my vision whirl just a little. Then Doctor Rembleski fitted me with rigid gas permeable lenses, and now I have awesome vision.

      - Rich M.
    • I have a pretty high prescription and over the years I had accepted that I just wasn’t going to have stellar vision. But I had no idea how clear and sharp my vision could be until I tried RGP lenses. I’ve been wearing RGP lenses for four years and couldn’t be happier.

      - Amy M.