Patient 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.)

• Patient Care [On-line Secured Registration Form]
• Financial Policy [PDF]
• Patient HIPAA Release Form [PDF]
• Medical Records Transfer Request Form – “To Us” [PDF] In order for your provider to release your medical records to us – they will require a signed medical release form.  You can use this form to request your medical records from your provider.

For Existing Patients, if you have not been examined the last 2 years,  please complete the patient care and financial policy forms above.

• Medical Records Release Form [PDF] If you would like us to release your medical records, you must first complete a medical release form.   Under HIPAA regulations, this form must be signed by the patient.  Completed forms can be mailed or faxed to our office.

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

• Tear Film Evaluation [PDF]

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!