All New Form

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Munster Eye Care Associates, P.C. to hire me. I attest with my signature below that I have given Munster Eye Care Associates, P.C. true and complete information on this application. No requested information has been concealed. I authorize Munster Eye Care Associates, P.C. to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed materials information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Careers Page Form

Personal Information

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Friends/Relatives

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Employment History

Employment

Personal References

References

Cataract Questionnaire Form

Contact Us Form

Request an Appointment Form

Cataract Self Test Form

1. How old are you?

2. Without my glasses and contacts... (check all that apply)

3. What do you usually wear? (check all that apply)

4. Do you have any of the following? (check all that apply)

5. Have you been told you have cataracts and require surgery?

Are the following statements important to you?

6. I would like to see well at a distance without relying on glasses and contact lenses.

7. I would like to see well up close without relying on glasses and contact lenses.

8. It is important to me to see well at night after cataract surgery.

9. Think about the things in life you want to do without depending on glasses after cataract surgery. Which group is the most important? (check all that apply)

10. Would you like to speak with one of our specialists?