Forms
Please see our Patient Forms below. Download and complete applicable forms to bring with you to your next appointment. Contact us if you have any questions.
Patient Forms
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Patient Information FormList Item 1
Every new patient and returning patients who have had a change in address or phone number must fill this form out at the oce or bring in a completed form. Please remember to sign and date the second page.
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Financial Agreement Form
Every patient must fill this form out at least once a year.
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Privacy Acknowledgement Form
Every new patient must fill this form out. Returning patients only need to complete this form if they have not done so before. Before signing this form, please read our Privacy Practices.
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Medical History Questionnaire
A full medical history is required not only by insurance companies, but also by the doctor, in order to best treat you. We ask that you complete one of these forms if you are a new patient, or are coming in for your regular eye exam.
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Records Release
This form only needs to be filled out if you would like to authorize our office to acquire records from another practitioner or if you need us to send your records to other practitioners.