1. Contact Usfillable Family Group Records Los Angeles County
  2. Family Group Sheet Fillable Pdf

Contact Looking for information about Medicaid, Adoption or Birth/Marriage/Death Certificates? This site answers many of the questions frequently asked about Medicaid, Adoption or Birth, Marriage, or Death Certificates.If you've tried those areas without success, you can e-mail Medicaid or e-mail Vital Records. Please contact the facility where the patient is being treated for information included in the facility’s patient directory. We cannot respond to medical records requests submitted via this website. If you need medical records, please contact the Release of Information Center at (865) 374-5269. Call us anytime at 1-800-MYAMFAM (1-800-692-6326). We are here for you.

The forms listed below include some of our most commonly used forms. Additional forms are available from our nationwide network of Archives facilities.

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When you place your order online we receive it the next business day and begin researching it right away. (Order Online links will open in a new window.)

Passenger Arrival Records(NATF Form 81)
Order Online Download the Form Use for
Federal Census Records(NATF Form 82)
Order Online Download the Form Use for
Eastern Cherokee Applications(NATF Form 83)
Order Online Download the Form Use for
Federal Land Entry Files(NATF Form 84)
Order Online Download the Form Use for

Military Pension/Bounty Land Warrant Applications(NATF Form 85)
Order Online Download the Form Use for
(Pre-WWI) Military Service Records(NATF Form 86)
Order Online Download the Form Use for
(Post-WWI) Military Records(SF-180)
Order Online Download the Form Use for

Note: NATF 80 is no longer used. Use NATF 85 for military pension and bounty land warrant applications, and NATF 86 for military service records for Army veterans discharged before 1912.

Order Records

These forms are available for you to download/print, sign, and return to us via fax or mail, as indicated in the instructions for each. At this time, these forms can not be submitted through our website.

Contact Usfillable Family Group Records Los Angeles County

Form NumberTitleReason to Use
SF-180Request Pertaining to Military RecordsOrder copies of military records.
NA Form 14115Independent Researcher Listing Application Form Request inclusion in our online listing of independent researchers.
NATF Form 36Microfilm Order Form
What's Available How to Order Microfilm
Purchase microfilm.
NATF Form 37Alien Case Files Order Form
What's Available
Order copies of Alien Case Files.
NA 14110Item Approval FormOrder motion pictures and sound recordings.
Request & Order ReproductionsRequest reproductions of Passenger Arrival Records, Eastern Cherokee Applications, and Compiled Military Service Records online.
VA 9957CRS Time Sharing Request Form
ACRS Time Sharing Request Form 2
Federal Agencies Only: Establish a time sharing account.

Copies of Nixon Presidential Materials

Form TitleUse For
Motion Film Order Form16mm, 35mm, color, or black and white motion film
Textual MaterialsPresidential and non-Presidential materials
Audiovisual MaterialsAudiotapes

Office of Government Information Services (OGIS)

TitleReason to Use
Consent to Make Inquiries and Release of Information and Records (NA Form 10003)Authorize the Office of Government Information Services to make inquiries on your behalf regarding requests for records under the Freedom of Information Act and/or Privacy Act filed with another federal government agency.

Employment

TitleReason to Use
National Archives Applicant Background SurveyApply for a job with the National Archives.

Grants

Form NumberTitle/Description
Standard Form 424 Application for Federal Assistance
  • New Requirement for Grant Applications – DUNS number
    Obtaining a DUNS Number
Standard Form 424BAssurances--Non-Construction Programs
Disclosure of Lobbying Activities (submit only if you have engaged in lobbying activities)
Other Grant Forms
State Historical Records Advisory Board Member Evaluation Form
Summary Recommendation of the State Historical Records Advisory Board Form

Records Management (For Use By Federal Agencies Only)

We are very pleased you have chosen Berks Eye Physicians & Surgeons to care for your eyes. It is our privilege to provide excellent medical care in a pleasant, friendly, patient-centered environment. Our practice offers a broad scope of medical and surgical eye services including state-of-the-art cataract surgery, laser vision correction (LASIK), and glaucoma management. We provide comprehensive family vision care, contact lens examinations, and dispense glasses and contact lenses. Emergency eye care is available 24 hours a day. Berks Eye has extremely qualified physicians and surgeons, certified technicians and opticians, and a caring support staff ready to assist you.

Please bring the following to your appointment:

  • Completed new patient forms
  • Current medical and vision insurance cards
  • Insurance referrals if required
  • Photo identification
  • List of medications that you use, their dosage, and frequency
  • Method of payment for copays and other charges due on the day of service (we accept cash, checks, VISA, Mastercard, Discover, and American Express)
Contact Usfillable Family Group Records

Your initial examination will take between 1-3 hours depending on the complexity of your examination. As a standard part of your visit, our technician may use drops that will enlarge your pupils. These “dilating” drops will cause light sensitivity and some blurring for several hours. We recommend having a driver for your trip home. Patients less than 18 years old must be accompanied by a parent or legal guardian.

If you are a current contact lens wearer, if possible, please bring a copy of your prescription or your boxes/vials with you to your appointment. Please also bring any back-up eyeglasses you may wear on occasion.

Please call us at (610) 372-0712 if you have any questions. Thank you for allowing us to participate in your eye care. We look forward to meeting you!

Please click on one of the links below to download the corresponding form:

Family Group Sheet Fillable Pdf

NEW PATIENT REGISTRATION FORM (.PDF)
(.PDF files can be downloaded, printed, filled out and brought to your appointment.)

(EDITABLE) NEW PATIENT REGISTRATION FORMS (.PDF)
(.PDF files can be downloaded, printed, filled out and brought to your appointment.)

MEDICAL RECORDS RELEASE

MINOR MEDICAL CONSENT FORM

LASIK CONSULTATION REGISTRATION PAPERWORK

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