Patient Information Form Every new patient and returning patients who have had a change in address or phone number must fill this form out at the office or bring in a completed form. Please remember to sign and date the second page.
Refraction Charge Form Patients coming in for a comprehensive exam must fill this form out, unless you are using a vision plan. Bear in mind that prescribing glasses is not a medically necessary procedure, and therefore will not be covered by most major medical insurances when performed during a medical examination.
Meaningful Use & Patient Portal This form asks additional questions required by new healthcare laws and provides registration information for our online patient portal. Every new or established patient must fill this form out.
Medical 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.
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.