Office Forms

You may download our office forms to complete at home prior to your visit. This can save you 10 minutes of paperwork when you arrive for your appointment.

Please Remember to bring your insurance and Medicare/Medicaid cards to each appointment.

Pediatric History Form for up to 5 years of age (2 Pages)
(Printer-Friendly PDF Format)

Adult History Form (2 Pages)
(Printer-Friendly PDF Format)

Records Release Form
(Printer-Friendly PDF Format)

Low Vision Patient History Forms (2 Pages)
(Printer-Friendly PDF Format)

For Referring Physicians - Low Vision Consultation Request
(Printer-Friendly PDF Format)

Please complete form(s), sign and fax it back to our office at 785-625-7490 (fax).

You may also mail form(s) to:
Kendall L. Krug, OD PA
2203 Canterbury
Hays, KS  67601