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Online Forms

At Prairie EyeCare Center, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReaderĀ® to download and complete the forms.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

Please print out these forms, fill them out and bring them with you to your first visit.

Patient Registration
Welcome to our Office Info

Privacy and Insurance Authorization
Permission to Examine Minor
Minor Consent Form

Want to join our team? Print off an application here.

Employment Application


Download the Free AdobeReaderĀ®

Contact Us

We look forward to hearing from you.

Location

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Hours of Operation

Our Regular Schedule

Broken Bow Office

Monday:

8:00 am-5:30 pm

Tuesday:

8:00 am-5:30 pm

Wednesday:

8:00 am-5:30 pm

Thursday:

8:00 am-5:30 pm

Friday:

8:00 am-5:30 pm

Saturday:

By Appointment

Sunday:

Closed