Patient Forms

Dear Patient,

We are happy that you have chosen our office for your eye care needs, and we would like to welcome you to our practice. We offer a full range of eye care services, ranging from eye examinations to surgical procedures.

In order to make the new patient process as smooth as possible, please fill out the new patient information sheets to the right. We would appreciate your filling them out as completely as possible and bringing them with you when you come for your appointment.

It would be helpful if you would bring a list of all the medications that you are taking.

If you had previously seen an ophthalmologist or optometrist, please contact them to send us your previous records. Please send the records release card to your prior physician to have your records sent to us.

Please bring your insurance cards with you and we will be glad to file your insurance for you. If you are enrolled in an HMO insurance plan, be sure to contact your primary care physician in order to obtain a referral. We must have your referral at the time of your appointment.

We have several Spanish speaking technicians. However, if you do not speak English you may wish to bring an interpreter with you to assist with communication.

If you are coming for a complete evaluation, your eyes will probably be dilated. This may blur your vision and you may wish to have someone drive you. If you have sunglasses please bring them with you, however we do have disposable sunglasses, for your convenience, should you need them.

If you have any questions, please do not hesitate to contact our office.

Welcome - (.pdf)

Records Release HIPAA Compliant Form - (.pdf)

Refraction Disclosure - (.pdf)

Health History Forms - (.pdf)

Insurance Authorization - (.pdf)

Patient Notice of Privacy Practices - (.pdf)

Patient Consent Form - (.pdf)

Patient Authorization To Disclose Information - (.pdf)