(603) 436-1773 Patient PortalRequest Appointment
Cataract Self-test

Patient Forms / Financing

Preparing for your first office visit is easy. Please download all of the forms below and fill them out in the comfort of your home to save time in the waiting room.


New Patient Introduction to Practice
New Patient Information
Authorization for a Minor 
Records Release Form

If you are scheduled for a Dry Eye Appointment please fill out the following form.

Dry Eye Questionnaire


Insurance information


NOTE:  Although we participate with a number of medical insurance plans, there are several vision plans we do not participate with.
Please check with your medical or vision plan provider for coverage. 
If you have questions, please contact our scheduling department at


CareCredit healthcare credit card for better vision


There is an easier way to pay for your vision care including cataracts, oculoplastics, glaucoma, and contact lenses or glasses.  Eyesight Ophthalmic Services is pleased to accept the CareCredit credit card, North America’s leading patient healthcare financing program. CareCredit lets you begin your procedure or purchase your eyecare immediately — then pay for it over time with monthly payments that fit easily into your monthly budget. Whether you’re considering cataract surgery, oculoplastic surgery, or it’s simply time for new glasses or contacts, CareCredit can help you see clearer, sooner.

Attention contact lens patients:  Significant savings are available when purchasing 6 month or 1 year worth of contact lenses.  Consider applying for Care Credit and spread your payments out over a 6 or 12 month period – with no interest!  Contact our contact lens specialist to learn more!

Payment Calculator

Your healthcare credit card

CareCredit is the credit card exclusively designed for healthcare services. CareCredit offers special financing on purchase of $200 or more* for healthcare procedures not commonly covered by insurance, including LASIK and Premium-IOLs. Why put off improving your vision tomorrow, when you can see clearer today?


*Subject to credit approval. Minimum monthly payments required. Visit for details.


Contact Us

Portsmouth Office
155 Borthwick Avenue, Suite 200 E.
Portsmouth, NH 03801
Fax: 603-427-0655

Exeter Office
192 Water Street
Exeter, NH 03833
Fax: 603-778-1055

Somersworth Office
267 Route 108
Somersworth, NH 03878
Fax: 603-692-7575