Patient Forms

Required

Email Authorization Form

For patients looking to send and receive protected health information (e.g. glasses/contacts prescriptions) through unencrypted email.

Consent Policy

For patients getting eye examinations and/or requesting services be rendered.

Other Forms

Medical History Form

For patients looking to fast-track their examination time, medical histories may be sent and received electronically!

Medicare Beneficiary Notice

For patients using Medicare insurance.

Release of Medical Information

For patients looking to send their records to their ophthalmologist, primary care physician, or other healthcare professional.

Have a Question, Comment or Concern?

Please contact us!