Patient Forms

 

The following forms are in Adobe Acrobat PDF Format. If you do not currently have Adobe Acrobat software, it is available for download at no cost on the Internet. Download Acrobat Reader 


Adult Forms (PDF):

New patient information

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New Patient Registration Form 

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Refraction waiver

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Health history

 

Pediatric Forms:

Pediatric Patient Registration Form 

Pediatric Health History Form


Miscellaneous Forms:

Minor Child Medical/Surgical Treatment Authorization Form

Protected Health Information Authorization Form

Authorization to Obtain and/or Release Records

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Contact_Lens_Service_Fee_Agreement

 

Privacy Practices

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Privacy Practices