Wink Eye Care
2721 Little Elm Pkwy, STE 210, Little Elm, TX 75068
P: 214-872-4177
F: 214-872-2177
info@winkeyecare.com

Online Patient Form

Welcome to our secure online patient information and medical history form. Our goal is to be friendly to the environment and reduce the use of paper. Please do your part in being GREEN. Please proceed to the appropriate form below.

Secure Patient Online Intake Form

All patients: If you are coming into our office for a yearly routine eye examination or for the first time, we will need for you to fill out this form out to the best of your knowledge. Insurances and HIPAA regulations require that this information is kept up to date on a yearly basis. Thank you for your time and cooperation.

If you have any questions feel free to contact our staff at 214-872-4177.




Existing Patients

Established patients: Our staff will provide you with an access code via email to review your demographics and medical history. If you see it on the email, please enter it here: (Hint: First Initial, Last initial, MMDDYYYY - no spaces)