Patient Information

Types Of Insurance We Accept

Patient Forms for Cunningham Vision Centers


If you've scheduled an eye exam at CVC, please download the following forms, and bring the forms with you to your exam.

You may also email the forms to our office: admin@cvcicare.com. For billing and insurance questions, please contact mbressler@cvcicare.com.

Patient History FormFill out completely, and bring to your exam.

Returning Patient Update FormFill out completely, and bring to your exam.

Patient Responsibility AgreementThis is a responsibility agreement with Cunningham Vision Centers, please read carefully and sign.
Please sign and bring to your exam.

Acknowledgment of Receipt of Privacy PracticesThis form is an acknowledgment that you have received a copy of the privacy practices, which you can view online or receive a copy at our office.

Patient Forms for Ann Arbor Location


Welcome Form

Retinal Imaging Form