Patient Information 

At Eye Surgical Associates, we want to make your experience with us as pleasant and as convenient as possible. On this page you will find all the information you need - from patient forms to information about our office - to help you on your way to better vision.

Patient Forms

• Adult Medical History
• Medication List
• Cataract Questionnaire
• Pediatric Questionnaire
• Pre-Yag Capsulotomy Patient Questionnaire
• Notice of Privacy Practices
• Acknowledgement of Notice of Privacy Practices 

Policies

• Clinic Policy
• Financial Policy

All forms are in PDF format. If you do not have a PDF reader, please click here for a free download. 
 

Our Office

Eye Surgical Associates 
1710 S. 70th Street 
Lincoln, NE 68506 
(800) 742-2224 
(402) 484-9000 

Hours of Operation 
Monday - 8:00 a.m. - 5:00 p.m. 
Tuesday - 8:00 a.m. - 5:00 p.m. 
Wednesday - 8:00 a.m. - 5:00 p.m. 
Thursday - 8:00 a.m. - 5:00 p.m. 
Friday - 8:00 a.m. - 4:00 p.m. 

To view a map of our location or to email us, vist our Contact Us page.