Crystal Eyes Vision Center Logo Crystal Eyes Vision Center Logo


The Crystal Eyes Vision Center logo

Save time by downloading our registration and standard office forms before your appointment. Links to these forms are provided below in PDF and MicroSoft® Word formats.


Download Entire Patient Packet (.pdf)
Download Entire Patient Packet (.doc)

Patient Information Form (.pdf)
Patient Information Form (.doc)

Vision Insurance & Patient Responsibility (.pdf)
Vision Insurance & Patient Responsibility (.doc)

Medical Insurance & Patient Responsibility (.pdf)
Medical Insurance & Patient Responsibility (.doc)

Our Mission (.pdf)
Our Mission (.doc)

HIPAA Privacy Notice for CEVC (.pdf)
HIPAA Privacy Notice for CEVC (.doc)

Eyewear Lifestyle Questionnaire (.pdf)
Eyewear Lifestyle Questionnaire (.doc)

Dry Eye Questionnaire (.pdf)
Dry Eye Questionnaire (.doc)

Cancellation & No Show Policy (.pdf)
Cancellation & No Show Policy (.doc)


The Facebook logo which links to the Crystal Eyes Vision Center Facebook page.


The Google Plus logo which links to the Crystal Eyes Vision Center Google Plus page.

Eye Examination Forms & Registration

To expedite your visit, we've provided the following on-line tools which can be emailed directly to our office upon completion.

To schedule an appointment, you can fill out the form below and submit to our office. We will respond within 24 hour. You may also call the number above to speak directly with a staff member.

Our registration forms are also provided here and can be emailed directly from the form.















Routine Exam Contact Lens Medical Exam

Monday Tuesday Wednesday
Thursday Friday


9:00 am - Noon 2:00 pm - 5:00 pm
















Routine Exam

Contact Lens

Medical Exam


Monday

Tuesday

Wednesday

Thursday

Friday


9:00 am - Noon

2:00 pm - 5:00 pm






Please note, our office REQUIRES at least 24 hour notice if you are unable to make it to your scheduled appointment. Failure to show up for an appointment, or cancellation less than 24 hours from the scheduled time, will result in a $25 office charge. This fee will be assessed to you, and will be forwarded to collections if not paid within 14 days.

We apologize for any inconvenience this may cause you. However, in order to operate our office in an efficient manner, we are forced to follow this rule very strictly.



Dr. Russell Fillmore and the staff at Crystal Eyes Vision Center are committed to providing a personal touch in your ongoing eyecare. We listen to your needs and treat each patient with an individual, customized care.

Crystal Eyes Vision Center ©
1164 Lexington Avenue
Mansfield, Ohio 44907
419.756.0500
appts@cevc.net

Hours of Operation

M-F: 8:00 am - 5:30 pm
SAT: Closed
SUN: Closed


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