Dr Brian L Townsend OD
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patient  forms

Patient Forms

When preparing for your appointment please bring the following with you..
  • Current glasses including existing Sunwear 
  • Insurance Cards 
  • Driver's License 
  • Favorite reading material 
  • Current list of medications 
  • About an hour of your time 
  • Please arrive 15 mins early 
Contact Lens Patients:
  • Wear your lenses to the exam 
  • Contact lens boxes if you have them 
  • A bottle of your solution 
  • Your lens case 
Patient Information Form
File Size: 658 kb
File Type: pdf
Download File

Patient Consent Form
File Size: 539 kb
File Type: pdf
Download File

Pupil-Dilation
File Size: 671 kb
File Type: pdf
Download File

Patient Record Access Request Form
File Size: 24 kb
File Type: pdf
Download File

Contact Us
King William Square
4917 Richmond-Tappahannock Highway, Suite 1-A
Aylett, VA 23009
Phone: 804-769-4362
Fax: 804-769-4363

Office Hours
Mon    8:30 am - 5:30 pm
Tue     8:30 am - 5:30 pm
Wed    8:30 am - 5:30 pm
Thu     8:30 am - 5:30 pm


Notice of Privacy Practices
Website by Eyefinity
  • Home
  • Our Practice
    • Location Directions and Map
    • Warranty Policy
  • Our Services
    • Biophotonic Scanner
    • ZEISS i.Scription
    • Optomap
    • Freeze Frame!
    • Transitions XTRActive
  • Patient Forms
  • Promotions
  • Eye Care Articles
  • Care Credit