Patient Forms

You may access the following forms to assist us with your care. Please print and fill out the following forms, then bring them to your appointment.

MEDICAL HISTORY FORM

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Financial Policy & Agreement

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RECORDS RELEASE FORM

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CATARACT LIFESTYLE FORM

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Patient Registration Form

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HIPPA POLICY

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Our Promise of Privacy and Consent to Patient Records

Our office is fully committed to compliance with HIPAA guidelines by

1. Providing appropriate security for our patient records.

2. Protecting the privacy of our patient’s medical information. 

3. Providing our patients with proper access to their medical records 

4. Appropriately maintaining our patient information and billing processes in  compliance with national standards

If you ever have any questions or concerns about your services or charges, we encourage you to call and ask for our Compliance officer.