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Patient Forms

Once you have set up your consultation appointment with us, we ask that you print out our patient forms and bring it with you to your visit.

 

New Patient Forms



This saves you time in the office and also helps us provide you with a faster service.

Patient Registration Form - This form allows us to get demographics and other important information such as current medications and surgical history.

This includes our Financial Responsibility Form - This form explains our office policies. Please note that copays, deductibles, coinsurances, refraction fees, and any unpaid balance is due at the time of check in . Our HIPAA Authorization Form is also included- This form authorizes us to protect your health insurance information and allows us to use your information to better care. You can also use this form to elect a representative for you. (To help schedule appointments, etc.)Patients, would you be interested in signing up to our Free Patient Portal? With the Patient Portal, you can:

  • Request an appointment
  • Send messages to our practice
  • Make credit card payments online

If you'd like to take advantage of this efficient tool, please contact our office and we will gladly provide you with the necessary information. You will receive a confirmation email from the Patient Portal that looks like this

 Along with your filled out forms, please also bring:

  • Insurance card(s)
  • Insurance referral (Kindly call your insurance company to determine if you require a referral from your primary doctor to see a specialist)
  • Driver's License or Photo ID

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