Coldwater
(517) 279-7927
142 E Chicago Rd Coldwater, MI 49036
Angola
(260) 665-5015
1202 N Wayne St Angola, IN 46703
Sturgis
(269) 659-4545
1409 S Lakeview St Sturgis, MI 49091 Medical Appointments Only

Online Forms

At Holicki Eye Center & Optical, 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.



Demographic and Medical History Form

Download & Print Form


Notice of Privacy Practice

Download & Print Form


Amsler Grid

Print Our Free Amsler Grid

Commonly used for Age-Related Macular Degeneration patients


Have Dry Eyes

Print Out Our Dry Eye Disease Information

About dry eyes and what you can do to help!


Having Cataract Surgery with Us?

Patients Having Surgery On A Monday

Patients Having Surgery On A Wednesday

For those of you that had cataract surgery with our clinic.


Want to share your experience?

Download and Print - Patient Testimonials


 Optical Payment Policies - Refraction Fee Agreement


Download the Free AdobeReader®

Hours

(Sturgis Office's Hours Vary - please call the office for more information)

Monday

8:00 am - 5:00 pm

Tuesday

8:00 am - 5:00 pm

Wednesday

8:00 am - 5:00 pm

Thursday

8:00 am - 5:00 pm

Friday

8:00 am - 5:00 pm

Saturday

Closed

Sunday

Closed

Monday
8:00 am - 5:00 pm
Tuesday
8:00 am - 5:00 pm
Wednesday
8:00 am - 5:00 pm
Thursday
8:00 am - 5:00 pm
Friday
8:00 am - 5:00 pm
Saturday
Closed
Sunday
Closed