Patient Registration  

   “ Come see how affordable QUALITY eye care can be ! “   

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 SALEM

established 1983

 

 304-782-1005      
 304-782-3303 (fax)
 

 Drs. Audia & Wickline 

 59 Water St.       

 Salem, WV 26426
 

 Monday         9 – 5

 Tuesday        9 – 7

 Wednesday   9 – 5

 Thursday      9 – 5

 Friday           9 – 5

 Saturday       9 – 1

  Salem Info or

  Appointment

 
 Dr. Audia

 Dr. Wickline

  

HARRISVILLE

established 1998

 

 304-643-2117      
 304-643-2116 (fax)
 
 Drs. Audia & Wickline
 1403 E. Pearl St.  
 Harrisville, WV 26362

 

 Monday          9 - 4

 Tuesday         9 - 4 **

 Wednesday    9 - 6

 Thursday       9 - 4 **

 Friday            9 - 4

 ** Office open but no

  planned patient care

    Harrisville Info or

  Appointment  

Welcome to our office! As a new patient, please bring your current glasses and insurance card(s) at the time of your visit. To streamline your checking in, we have placed your registration forms on-line. One is a our HIPAA compliant consent form while the other is our history form. Please print and complete one of each and bring them with you at your first visit with us. For your convenience, we have each form in Microsoft Word and Adobe PDF. You can receive a free download of the Adobe PDF file here Adobe Reader   Get Acrobat Reader. Use your browsers back key to return to this page after you select your form.

 

Patient History and Consent (Word)     or    Patient History and Consent.pdf (Adobe PDF) Adobe PDF icon

Infant History and Consent Form (Word)   or   Infant History and Consent  Form.pdf (Adobe PDF) Adobe PDF icon

 

Send mail to draudia@wveyes.com with questions or comments about this web site.     Copyright © 2008 Drs. Audia & Wickline     Last modified: 05/05/08