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Online Forms

At Lock Family Eye Care, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

Medical History Forms - Required 

Please complete the following medical history forms to help us better understand your unique situation. 

Download & Print Medical History Front Form 1 

Download & Print Medical History Back Form 2 


Insurance Release Form 

The insurance acknowledgement form gives Lock Family Eye Care the authorization to filewith your insurance company

Download & Print Form 


Download the Free AdobeReader®

Welcome to Lock Family Eye Care

Your Optometrist in West Des Moines, IA.

Office Hours

9:201 Jordan Creek Pkwy # 12190 West Des Moines, IA 50266 *M-F, we take the last appointment at 5:20pm

Monday:

9:20 am-6:30 pm

Tuesday:

9:20 am-6:30 pm

Wednesday:

9:20 am-6:30 pm

Thursday:

9:20 am-6:30 pm

Friday:

9:20 am-6:30 pm

Saturday:

9:20 am-4:00 pm

Sunday:

11:30 am-4:00 pm

Location

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