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Home » Contact Us » Patient Registration Form

Patient Registration Form

Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office.

This form contains confidential information and is delivered to your doctor through a secure Internet connection.

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Saginaw

Hemlock

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Due to the current circumstances, the office will be open by appointment only for contact lens pick- ups & spectacle pick-ups. Office hours will be Monday- Thursday 8:00 am. – 5:00 pm. & Friday 8:00 am. – 12 pm. If it is after hours and is an emergency please call the Doctor on call @

(989) 280-9799.

Thank you for your understanding

Dr. Kocks, Dr. Kaczmarczyk & Staff