Patient Forms

Name: CustomEyes
Address: 3660 NE Ralph Powell Rd, Lee's Summit, MO, 64064, US
Telephone: 816-524-7400
Price range: $000 - $300

To make your visit faster, please submit the Patient History Form below. If you have any questions, feel free to call us.

Medical History Questionnaire
Medical Form

Protecting our Patients from Coronavirus

Custom Eyes will be rescheduling all routine eye care as of March 24th. We will suspend all routine vision care and normal office accessibility but we are still here for you!

CLICK HERE TO SEE THE LATEST CORONAVIRUS INFO FROM OUR PRACTICE

Patient Forms

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Lee’s Summit

Lenexa

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Lee’s Summit

Lenexa

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