Patient Forms

Print and fill out relevant forms before your office visit.

Patient Forms

Please feel free to download and fill in this new patient form. Bring the printed patient form to your eye appointment to streamline the intake process. This allows us to enter your personal information into our computers as you are being seen by one of our eye care professionals.

HIPPA Information

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review this downloadable file carefully, sign it and bring to your next eye appointment at Broome Optical.

Lipiflow / Dry Eye

If you are experiencing dry, itchy, red or even watery eyes, you may have chronic dry eye syndrome. Broome Optical suggest LipiFlow treatment for this condition. To sign up for a dry eye assessment at our office, please fill out and return this form to us at your appointment.


monday - friday: 7 a.m. - 6 p.m. saturday: 8 a.m. - 1 p.m. | sunday: Closed

come see us

3408 Olsen Blvd. Amarillo, Texas 79109

806.355.5633 | Toll Free: 800.344.0430 | Fax: 806.355.9133

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The Payment Option for Healthcare Services.

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