Welcome to The Vision Center at Seaside Farms

Thank you for choosing Dr. Bodkin or Dr. Boiwka for your eyecare needs. We are delighted to have you as a patient and look forward to caring for your eyes. Please take a moment to complete the following information. If you would prefer to print the form out and bring it with you, send an email to info@seasidevision.com and we will send it to you. You can visit http://www.seasidevision.com/what-to-expect.html to learn what will occur during your eye exam. If you have any questions, please do not hesitate to call us at 843-388-6200 or email us at info@seasidevision.com
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    Insurance Information

    If you do not plan to use insurance for your visit, you can skip this section. If you are filling this form out in our office, you can skip this section.
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    Patient's Health History

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    Spectacle Lens History

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    Contact Lens History

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    Social History

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    If you are filling this form out in our office, please DO NOT hit the SUBMIT button below. Please just hand the iPad back to someone at the front desk. Thank you.