Family Vision Care of Ponca City
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Download Medical Forms

1619 North 5th Street
580-762-5700
Pay Online

​Medical History Form *Requested

DOWNLOAD FORM

New Patient Form​ *Requested

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HIPPA

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Release of Records​

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Please print, fill out and fax to 580-765-3022 or email to [email protected]
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Contact
1619 North 5th Street
Ponca City, OK 74601
Hours: 8am - 5pm, Mon-Fri
MAIN: 580-762-5700
FAX: 580-765-3022
[email protected]
Helpful Links
Think about Your Eyes
Vivance - Children's Eye Health
Center for Disease Control
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  • Home
  • Services
  • Optical
  • Forms
  • Meet Our Doctors
  • Contact
  • Social-Eyes