D'ALONZO FAMILY EYECARE
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Patient Forms

Patient Forms


To save time, these forms can be filled out prior to your appointment. We ask that pediatric patients (under age 18) fill out the Pediatric Questionnaire. ​
Medical Questionnaire
File Size: 148 kb
File Type: pdf
Download File

Pediatric Questionnaire
File Size: 140 kb
File Type: pdf
Download File

Contact Us
420 North Springfield Road
Clifton Heights, PA 19018
Phone: 610-626-9124
Fax:  610-626-0901
Email:  tdalonzo@aol.com
After Hours Emergency: 610 745-8672
Office Hours
Mon    10:00 am - 6:30 pm
Tue     9:00 am - 5:00 pm
Wed    1:00 pm - 7:30pm
Thu     9:00 am - 5:00 pm
Fri       10:00 am - 5:30 pm
Sat      9:30 am -1:00 pm


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Website by Eyefinity
  • Home
  • Our Practice
    • Our Staff
    • Insurance
    • Location
  • Our Services
    • Myopia Control
    • Scleral Contact Lenses
    • iWellness Exam
    • LASIK
  • Schedule Appointment
  • Patient Forms
  • Eye Care Articles