Patient Forms

Please fill in the New Patient Welcome Form.
Please fax the forms to (216) 642-7383, email to OA@drsglosik.com, 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

Contact Us
Optometric Associates 
​ Drs. Glosik, Cerny & Cerny
7305 Broadview Road, Suite F
Seven Hills, OH 44131
​Email: OA@drsglosik.com
Phone: 216-642-7373
Office Hours
Mon    9:00 am - 5:30 pm
Tue     9:00 am - 5:30 pm
Wed   9:00 am - 5:30 pm
Thu     9:00 am - 5:30 pm
Fri       9:00 am - 5:30 pm
Notice of Privacy Practices