Georgia Department of Motor Vehicles Vision Form

You have two options to complete this form:

Manual Process:
1. Download the form.
2. Fill it out manually.
3. Scan the filled form.
4. Upload the scanned form here.

Complete Manual Process

Online Process:
1. Fill out the form online.
2. Your information will be automatically added to the PDF.
3. No need to scan or upload anything.

Complete OnLine Process

Online Process

Patient's Last Name(Required)

Patient's First Name(Required)

Mailing Address(Required)

City / State(Required)

ZIP Code(Required)

Customer’s Driver License Number (DL#)(Required)

Email

Date of Birth(Required)

The other forms are optional for the reasons explained in their respective field.

Authorization to See a Minor

Use this form if your child will be seen at Smyrna Eye Group and a parent or legal guardian is not able to be present at the time of the examination.

Download Authorization to See a Minor

Georgia Department of Public Health Form 3300

* There is a fee for the testing required to complete this form, contact us for more information.

Complete the Georgia Department of Public Health Form.

Download Georgia Department of Public Health Form 3300

HIPAA Privacy Notice

Download the document to review our adherence to stringent privacy and security standards.

Download HIPAA Privacy Notice

Georgia Department of Motor Vehicles Vision Form

* There is a fee for the testing required to complete this form, contact us for more information.

Complete the Georgia DMV Vision Form .

Download Georgia Department of Motor Vehicles Vision Form

Pre-Examination Registration

Prior to arriving for your eye examination, we recommend every patient complete the online web registration.

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Pre-Examination Checklist

We recommend that you complete the online web registration form prior to your eye examination.

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Insurance Plans Accepted

A variety of accepted Insurance Plans cover Vision Insurance, offering benefits for eye examinations, eyeglasses, and contact lenses through separate providers.

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