Online Forms

At Dr. R Kirk Smithhart, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

New Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals you have regarding your eye health or vision on the form.

Download & Print Form


Download the Free AdobeReader®

Contact Us

Hours of Operation

Our Regular Schedule

Jackson Office

Monday:

8:00 am-5:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

8:00 am-5:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

Location

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Testimonials

Reviews From Our Satisfied Patients

  • "Thank You Dr. Smithhart for a great vision check you was so patient with me when it come to my head and eyes I am very sensitive now I can see thank you"
    Betty S.
  • "One of the world's greastest eye doctor been coming to Dr. Smithhart for many years me and my kids I will recommend him to anyone."
    Sandra S.

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