PATIENT FORMS

NEW PATIENTS should bring their most recent pair of glasses and contact lens prescription (or alternatively contact lens boxes or blister packets), if applicable, with them to their appointment.  They should expect to have their eyes dilated at the time of the visit.  Sunglasses will be provided if needed at the end of the exam.  Please be advised that some patients may experience difficulty driving with their eyes dilated so it may be advisable to bring a driver.

THE FOLLOWING FORMS should be carefully read and filled out prior to the initial office visit.  The completed forms along with a photo ID and health insurance card, if applicable, should be presented upon arrival.  New patients are also responsible for providing a referral form from their primary care physician before the exam if required by their health plan to avoid higher out-of-pocket expenses they would otherwise incur for the visit.  New patients need to click on the four links (in bold) below to print and completely fill out all the required forms before the initial appointment and present these upon check-in:

• Patient Registration Form
• Patient History Form
• Routine Vision Policy
• HIPAA Notice (click to download Notice of Privacy Practices – Effective Date of Notice 09/21/13)