New Patient Registration Form

The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time, you will save a significant amount of time during your visit.


If you do not have a copy of Acrobat Reader you can get one for free by clicking  ‘Get Acrobat® Reader‘. This will take you to Adobe’s website and enable you to download the Acrobat program to your computer.

Please be prepared to provide this information to our office along with your current insurance information.

If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit.

Contact Us


Woodlawn Shopping Center Belt and Beck

2229 North  Belt Hwy, St Joseph, MO 64506


Monday & Friday                 9:00 a.m. to 5:00 p.m. Tuesday                             9:00 a.m. to 6:30 p.m
Wednesday & Thursday        9:00 a.m. to 6:00 p.m.


Get Directions 


2229 North Belt Highway  •   Saint Joseph, Mo  64506  • 816.671.0500
Open Monday / Friday, 9am to 5pm • Tuesday, 9am to 6:30pm • Wednesday
 / Thursday, 9am to 6pm

Get Directions                     © 2018 by Dr. Rosenak's Optical Options, Inc     

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