Merrimack Eye Clinic
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CALL 978-452-2100

Se Habla Espanol

1230 Bridge St., Rt. 38
Lowell, MA 01850
Tel 978-452-2100
Fax 978-446-0490
Merrimack Eyewear
Mon 8:00AM-6:00 PM
Tues 8:00AM-7:00 PM
Wed 8:00AM-5:00 PM
Thu 8:00AM-5:00 PM
Fri 8:00 AM-5:00 PM
Sat 8:00 AM-1:00 PM
Patient FormsPatient Forms

If you are new to our practice or need to update your records, we encourage you to download and print the new patient forms. By filling out these forms ahead of time, you will save significant time during your visit.

Please complete these forms the best that you can and bring them at the day of your visit. If you have any questions when filling out these forms, give us a call prior to your visit or our staff will assist you on the day of your visit.

(please click on forms to download)

New Patient Registration Form   Spanish Version
Medical History
Financial Agreement
Lifestyle Survey

Along with these forms, please do not forget to bring:

1) Your insurance card
2) List of medications such as eye drops, ointment
3) Previous/existing eyeglass prescription
4) Current eyeglasses
5) Previous/existing contact lens prescription and/or boxes

If you need a referral, please make sure that you ask your primary care physician to issue one before your appointment date.

Need Surgery?

Our Doctor has surgical privileges at various area hospitals. Our surgical coordinator will ensure that the doctor’s schedule is in sync with the time, date, and location that is convenient for you.


We accept most medical insurance plans, eyewear and vision plans, and other commercial health plans. More

  John Capino, MD
Sight Matters