New Patient Forms

New patients must complete a variety of forms prior to seeing the physician. Below are the forms that must be completed. You can print these at home and complete them at your convenience prior to arriving at the office. Click on the title to display the form.

Patient Information Form

New patients must complete this form prior to seeing the physician on their first visit.

Medical Information Review

New patients provide their medical history on this form. It must be completed by all new patients.

Refraction Notice

A refraction is the part of an eye exam to determine the prescription for corrective lenses. Historically, most insurance plans do not pay for this portion of an eye examination. If you need a prescription for corrective lenses, please see this notice regarding payment for this portion of your exam.

Contact Lens Prescriptions

The prescription which may be given to you following your examination is for glasses only. The evaluation required for fitting contact lenses must be done separately. See this form for additional information.

HIPPA Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

HIPPA Release

This form allows you to give us authorization to provide information to others you specify.

 

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