Shades of Brooklyn
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Our practice is here to offer you the best in eye care

Patient Forms


 Demographic, medical history and insurance forms will be available electronically via our Patient Portal or 𝑐𝑙𝑖𝑐𝑘𝑖𝑛𝑔 𝑜𝑛  𝑁𝑒𝑤 𝑃𝑎𝑡𝑖𝑒𝑛𝑡 𝐼𝑛𝑓𝑜/𝑀𝑒𝑑𝑖𝑐𝑎𝑙 𝐻𝑖𝑠𝑡𝑜𝑟𝑦, please fill them in before your visit.
Signing "Acknowledgment of Receipt of Privacy Practices" on the form signifies that you have read the Privacy Policy, listed below.

  • New Patient Info/Medical History
  • Privacy Policy

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Try our integrated forms below:


Shades Of Brooklyn

1619 Pitkin Avenue
Brooklyn, New York 11212

Phone: 718-342-4300
Fax: 347-350-6601
Email: [email protected]

Office Hours
Mon - Fri 9:00 am - 5:00 pm
Sat  9:00 am - 3:00 pm

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Notice of Privacy Practices.
  • Home
  • Services
  • Schedule Appointment
  • Reorder Contact Lenses/Glasses
  • Patient Portal
  • Our Team
  • Patient Forms