Holliston Vision Center

841 Washington Street, Holliston, MA 01746

FOR NEW PATIENTS:


Notice of Privacy Practices (.pdf) -  Print the last page and bring the signed form to your exam.


Patient History Form (.doc) -   Fill this out and bring it to your appointment.  This provides us with your personal medical history and insurance information.


Patient History Form (.pdf) -  Use this form for PDF format printing.



FOR MEDICARE PATIENTS ONLY:


Medicare Authorization Form (.doc) -  Fill this out and bring it to your appointment.



FOR NEW AND EXISTING PATIENTS (IF NEEDED):


Record Release Form ​(.doc) - This enables us to secure information from your previous or existing eye doctor. 

We look forward to seeing you soon!

How to find our office:



Patients under the age of 18 must be accompanied by a parent or legal guardian.If the minor is not accompanied,  he/she must have a statement signed by the parent or guardian that authorizes treatment.  Photo identification or proof of guardianship may be requested.


Bring your insurance card to each visit.  For those without insurance, payment is due at the time of services.


Please wear your contact lenses to your exam and bring your care solutions and eyeglasses.  Contact lens wearers who are new to our office should also bring their contact lens prescription or old contact lens boxtops for parameter identification purposes. 

Patient Instructions & Forms:

​​ 508-429-1330
Mon. & Fri.   8 a.m. to 4 p.m.
Tues. & Thurs.   9 a.m. to 4 p.m.
Weds.  9 a.m. to 7 p.m.


Holliston Vision Center
841 Washington Street, Holliston, MA 01746
Telephone:  508-429-1330
FAX:  508-429-0922
E-mail: drjeunod@gmail.com

E-mail: drlapagliaod@gmail.com


Use the form below to contact us with your general questions! Please do not use this to schedule or cancel an appointment or for any confidential medical information.