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Patient Forms

Downloadable patient forms that you can print and fill out before your next visit to Advanced Eyecare & Vision Gallery in Hillsborough.

For your convenience, we have created the following pages to provide you with a list of the insurance carriers we accept at our Hillsborough optometric office, as well several downloadable forms to save you time at your next appointment.

Downloadable Forms

For New Patients, please complete the secure on-line “patient care” registration form. This will be greatly appreciated, as it provides us with the most accurate information to best care for you, our valued patient …and this will save you 30 minutes of in-office time on the day of your appointment!  (If you are unable to provide this information ahead of time, we understand, and ask you to arrive 30 minutes before your appointment time to complete the registration process.  Please be sure to bring a written list of all your current medications, including over-the-counter medications and food supplements, and the names of the prescribing doctors.)

For Existing Patients, who have not been examined here since we converted to electronic health records on September 20, 2009, please complete the new patient registration and financial policy forms above, which will trigger the conversion of your paper file to our electronic system.

For EXISTING PATIENTS returning for tear film analysis, please complete:

What to bring to your appointment:

Contact lens patients need to wear their contact lenses, bring their glasses, solution and contact lens case.

All new patients need to bring all glasses you wear, including sunglasses, sports glasses, computer glasses, reading glasses, driving or “TV” glasses, hobby glasses, etc.   If you wear contact lenses, please bring all the prescribing information such as power, base curve, diameter, solutions.

As a friendly reminder, some insurance policies may require a referral or pre-authorization to see a specialist.  Our doctors may be considered a specialist by your plan.   It is the patient’s responsibility to present the necessary referral and any necessary approval to our office at time of appointment.  If we do not have the required referral or approval at the time of appointment, you will be personally responsible to pay for all services rendered.

Thank you, and we look forward to seeing you soon!