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At Samantha Slotnick OD, FAAO, FCOVD, 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.

  • Please download, print and fill out all needed forms (AdobeReader® required).
  • Please contact Jane, our Patient Care Coordinator, to determine which forms you will need. Jane@DrSlotnick.com. 845-519-3521.
  • You can return forms via fax (914-885-1463) or scan/email to Jane@DrSlotnick.com.
  • Remember to bring originals with you to the first appointment.

Printable Forms:

New Patient Health History Form, Basic, Adult

New Patient Extended History Form – Children

New Patient Extended History Form – Adult

Record Release

Quality of Life Questionnaire

Educator's Checklist

Report Request

Adults with Strabismus Questionnaire

Brain Injury Visual Symptom Survey

InfantSee Intake

Directions via Public Transportation / train schedule / bus 20/21 schedule

HIPAA Privacy Policy

Download & Review Form