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 AdobeReaderĀ® 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 AdobeReaderĀ®

Contact Us

We look forward to hearing from you.

Hours of Operation

Our Regular Schedule

Tupelo Office


8:30 am-5:30 pm


8:30 am-5:30 pm


8:30 am-5:30 pm


8:30 am-5:30 pm


8:30 am-12:30 pm






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

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