Patient Forms
Access our patient forms that you can fill out before your next visit to Dr. George W. Pegram III, O.D. in Chesapeake.
Our Forms
**Please fill out a New or Established Patient Form and bring with you to your upcoming visit.*** We ask that all patients bring a list of medications if any are being taken.***
- Returning Patient Forms [PDF]
- New Patient Forms [PDF]
- HIPPA [PDF]
- Nondiscrimination Act [PDF]