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Order 2 pair of glasses, get 40% off on the 2nd pair. Some restrictions apply. Or, get $10 off your eye exam when paying with cash or credit on the day of the exam, excluding insurance!

Online Forms

At Dr Rod Kaufman, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReaderĀ® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

New Patient Intake Form 

Previous Patient Intake Form