OPTOMETRIC ASSOCIATES DRS. GLOSIK, CERNY & CERNY
  • Home
  • Location
  • Eye Exams, Contacts, Optomaps
    • No Vision Plan? We can help.
  • Our Team
  • Eyeglasses
    • Designer Eyewear
  • Glasses Packages
  • What Our Patients Say
  • Patient Forms
  • Eye Care Articles
  • Office Policies
  • Myopia Management

Patient Forms

Please fill in the New Patient Welcome Form.
Please fax the forms to (216) 642-7383, email to [email protected], or bring them to your appointment.  

Thank you and we look forward to seeing you!

new_patient_adult.pdf
File Size: 300 kb
File Type: pdf
Download File

new_patient_pediatric.pdf
File Size: 184 kb
File Type: pdf
Download File

new_patient_infant__under_1_year_.pdf
File Size: 165 kb
File Type: pdf
Download File

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Contact Us
Optometric Associates 
​ Drs. Cerny, Cerny & Glosik

7305 Broadview Road, Suite F
Seven Hills, OH 44131
​Email: [email protected]
Phone: 216-642-7373
Office Hours
Mon    8:45 am - 5:30 pm
Tue    
8:45 am - 5:30 pm
Wed   9
:45 am - 5:30 pm
Thu     8:45 am - 5:30 pm
Fri      
8:45 am - 5:30 pm

Notice of Privacy Practices

  • Home
  • Location
  • Eye Exams, Contacts, Optomaps
    • No Vision Plan? We can help.
  • Our Team
  • Eyeglasses
    • Designer Eyewear
  • Glasses Packages
  • What Our Patients Say
  • Patient Forms
  • Eye Care Articles
  • Office Policies
  • Myopia Management