Patient PHR & Forms

Drs. Douglas & Victoria M. Weiss, Optometrists are happy to introduce


How do I access RevolutionPHR?

Click on the link above. Your username is your email address.

If this is your first time logging into RevolutionPHR and you have not received your temporary password, please call our office at 434.591.0262

What is RevolutionPHR?

The acronym PHR stands for “Personal Health Record” and represents an online location where you and only you can view important information about your relationship with us.

RevolutionPHR utilizes the highest standards of online security while allowing you to view portions of your eye care record through any standard Internet browser on a PC or Mac computer or an iPad We encourage you to use the Login information created specifically for you to review the many features available.

You can decide if access to RevolutionPHR is right for you, and participation is completely optional. We have no record of your access and we allow you to use this online portal at your discretion.

What can I do in RevolutionPHR?

  • Update us with changes in key information such as new phone numbers, email addresses, addresses, and more.
  • Complete your pre-exam interviews online. This information automatically is added to your patient chart in our system which leads to a more accurate and efficient exam.
  • Schedule your appointments at your convenience online if you are an existing patient with our office. A limited number of appointment times are available online for a comprehensive examination. Please call our office for other appointment times and for other types of exams. Our office is happy to schedule appointments that suit your schedule (434) 591-0262
  • Check the status of glasses and contact lens orders.
  • See billing statements.

New Patient Forms

Please click on the links below to download and print our new patient forms.  If you have any questions, or need assistance, just bring the partially completed form along for your appointment.

Consents and Financial Responsibilities

Contact and Privacy Form

Health History