Skip to main content
Myeyetore logo 2

Adjacent to the Constitution Bank and The Peasant Grill on Broad Street


At the Intersection of River Rd (RT 29 & Rt 179) and Bridge Street


For 24/7 Emergency Eyecare Services call: 609-213-5008. Contact Us.

Home » Contact Us » COVID Questionnaire form

COVID Questionnaire form

  • COVID Patient – Staff Questionnaire: MUST BE Completed and Signed prior to services being delivered. Please complete - print - and present at your appointment

    Potential Exposure means being in a house-hold contact or having a close contact within less than 6 feet of an individual with confirmed or suspected of COVID -19 (or other communicable contagion or disease). The timeframe for having contact with an individual includes the period of time one week before the individual has been potential exposed with consider incubation of 30 days. As such: we are mandating that all staff and patients read and sign the following:
  • PT’s entering temperature will be collected by staff Temp over 99.5F be to re-scheduled and asked to seek medical care
  • Our offices are stringently following the guidelines of the CDC, NIH, AOA, AAphth. and other health agenices to safe guard our staff and patients, as seen on our website notice and posted notices in the office. The questions above are related to COVID or any other highly contagious disorders on a case by case basis. It is the discretion of the doctors of the offices of Hopewell and Lambertville Eye Associates to determine if it is appropriate to tend to the care of the individual based on the responses and the potential of risk to staff and other patients.

    Any false claims on this document will imply full liability for damages by the individual sigining this document representing themselves or any individual in their care. If care is deemed inappropriate at this time due to safety concerns, this is not deemed as a discriminatory act, but an act of protection and safety for all individuals. If a patient does not abide by the offices policy to maintain proper PPE or social distance, other than working directly, care will not not be delivered to the individual and not deemed discriminatory.

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY

Call Our Locations

Call Lambertville 609-451-3992

Call Hopewell 609-288-2090


Hopewell – Lambertville Eye is for patient care. Please read the COVID-19 Safety protocols:   Read Our Office Policies…

Contact us at:        Call for Emergency: 609 – 213 – 5008

Please complete patient registration form and COVID questionnaire or (Espanol) Patiente – COVID prior to your appointment

For appointment requests:

Please Avoid Coming to the office for contact lens orders and eyecare products: Go to our Online Store at:                                                       or Go to Order Contacts: