Online Forms

At Kea Eye Center, 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.


help us continue providing fast, easy services

In an effort to maintain our position as the area's most convenient and most efficient optometry office, we'd like to share forms with you that expedite the rate at which we are able to help you and other customers.

Filling Out Forms is Fun!

Maybe "fun" isn't the right word... but the fact of the matter is this form are an important part of helping provide you with top quality eye care. So please print them, and bring them along on your visit!

Convenience is Key

We aim to make your visit as quick and easy as possible. In addition to expediting administrative necessities, we also have our very own in-house surfacing lab. This enables us to fabricate, tint, coat, harden, and repair edge spectacle lenses and get them back to you on the same day!

You can also take advantage of our same-day service on Mississippi Medicaid glasses.


Medical History Questionnaire

Download & Print Form


Download the Free AdobeReader®

Contact Us

We look forward to hearing from you.

Hours of Operation

Our Regular Schedule

Tupelo Office

Monday:

8:30 am-5:30 pm

Tuesday:

8:30 am-5:30 pm

Wednesday:

8:30 am-5:30 pm

Thursday:

8:30 am-5:30 pm

Friday:

8:30 am-12:30 pm

Saturday:

Closed

Sunday:

Closed

Location

Find us on the map

Testimonial

  • "Anderson Optometry is the best at what they do and make you feel right at home."
    John Doe San Diego, CA
  • New Year, New Vision in 2020

    Tired of squinting when you read? Add an eye exam to your list of New Year's resolutions. ...

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  • How To Read Your Eyeglass Prescription

    Have you ever wondered what your eyeglass prescription says about your vision? ...

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  • Are Floaters A Sign Of Something Bigger?

    Worried about floaters? Find out when this common vision symptom can be a sign of a serious problem. ...

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  • Frequently Asked Questions

    Why do I need to see an eye care provider? Many “silent” diseases, such as glaucoma and diabetes, can only be detected through regular eye exams. When these conditions are discovered earlier rather than later, they become easier to treat or manage, allowing for better long-term preservation of eyesight. ...

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  • Pediatric Ophthlamology

    Ophthalmology addresses the physiology, anatomy and diseases of the eyes. Pediatric ophthalmology focuses on the eyes of children. Pediatric ophthalmologists examine children’s eyes to see if they need corrective lenses or other treatments to improve their vision. Training for Pediatric Ophthalmologists Pediatric ...

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  • Allergies

    Caused by the same irritants as hay fever, runny nose, coughing, and sneezing, eye allergies commonly affect those who suffer from other allergy symptoms. Not only do eye allergies cause discomfort, but they can also interfere with daily activities. Eye Allergy Causes Medically referred to as allergic ...

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  • Learning-Related Vision Problems

    Learning disabilities may include dyslexia, math disorder, writing disorder, auditory processing deficits, or visual processing deficits. Although each child with a learning disability is unique, many also have associated visual problems. Addressing these vision disorders may alleviate some symptoms ...

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  • UV Radiation and Your Eyes

    Optometry warnings about the damaging effects of ultraviolet radiation on our eyes have not yet reached the degree of public awareness of that of skin damage. Yet, the sun can be just as damaging upon our eyes with unprotected exposure. Short-term exposure to very bright sunlight can result in a type ...

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  • How To Protect Your Eyes While Wearing Halloween-Themed Contact Lenses

    Spooky novelty contact lenses can make your Halloween costume even scarier, but are they safe? ...

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  • Fuchs' Corneal Dystrophy

    Fuchs' dystrophy (pronounced fooks DIS-truh-fee) is an eye disease characterized by degenerative changes to the cornea’s innermost layer of cells. The cause for Fuchs' dystrophy is not fully understood. If your mother or father has the disease, then there is roughly a 50 percent chance that you will ...

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