Graf Optical is passionate
about providing the best quality care
for our patients as well as exceeding
the expectations of our referring physicians.
Our online resources are provided to
assist in making your visit or referral
as convenient as possible. Click on the
links below to open and download or print
our forms. Once completed, fax or mail
the form to Graf Optical.
HIPPA Notice of Privacy Practices
Please read and sign this form and bring it with you for your exam. This only needs to be completed upon your first visit.
Patient Registration Form
Please fill out the highlighted portions and bring this form with you for your exam. A new form must be completed every year.
Visual Field Consent Form
Humphrey Matrix™ Perimeter
The Matrix Perimeter utilizes Welch Allyn Frequency Doubling Technology. It represents a significant breakthrough in visual field testing by combining early glaucoma detection capabilities, tools to characterize glaucoma and basic glaucoma management tools.
Like the Humphrey® FDT® Perimeter, the Matrix doubles as an in-office glaucoma screener with 35 second supra-threshold testing. And it provides up to 69 stimuli to characterize visual field defects to facilitate accurate diagnoses.
Patient management software The Humphrey Matrix Perimeter comes equipped with Glaucoma Asymmetry Test and serial field overview software for comprehensive threshold exams and charting change over time. It is clinically validated by numerous studies.
Patient friendly The Matrix Perimeter's video eye monitoring feature simplifies patient alignment and fixation control. An eye patch isn't required and trial lenses are only needed beyond +/- 3 diopters. It includes enhanced optics for 30° Field of View (FOV). The Matrix performs dependably in ambient light so there's no need to darken the room.
Matrix test results are presented on an LCD color display and can be printed on an external color printer. Matrix can store up to a million exams for historical analysis.
VSP Patient History Questionnaire
VSP patients please complete this form and bring it with you for your exam. A new form must be completed each year.
Hours of operation:
Monday through Thursday: 9-7 P.M.