Belton Eye Care Center - Patient Forms
Belton Eye Care Center

If you are a new or returning patient, please print, fill out this form and bring it to your appointment.

All patients must complete and sign the Acknowlegement of the Notice of Privacy Practices form. This is included in your Patient Information Form. To view the Notice of Privacy Practices, click on the link below.

You may obtain a copy of the Privacy Practices at the time of your visit.

Completing the information on this form will assist our staff in providing comprehensive medical care during your visit. At your visit, additional information specific to you may be requested.


  These PDFs require a free plugin that may have come included with your browser. If you are having difficulties opening these files Click Here to go to Adobe's web site for Adobe's PDF reader.

2609 North Main Street
Belton, TX 76513
Map It!

Phone: (254) 939-5261
Fax: (254) 939-6610
Email Us

Mon-Thu 8:00am - 6:00pm
Fri 8:00am - 4:30pm