Patient Forms

Patient information and forms are available for you to download, print, fill out, sign and return on your next visit.

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NEW PATIENT FORMS

Assignment of Medicare BenefitsPrint & Fill Out

Financial Assignment SheetPrint & Fill Out

Financial Assignment Sheet (Spanish)Print & Fill Out

HIPAA Notice of Privacy PracticesPrint & Fill Out

Patient Information SheetPrint & Fill Out

Patient Medical InformationPrint & Fill Out

HIPAA Compliance Plan

HIPAA Security Plan

Red Flag Rule Policy

Medical Records Release FormPrint & Fill Out

SURGERY FORMS

Cataract Surgery QuestionnairePrint & Fill Out

LASER VISION CORRECTION FORMS

CustomVue Advantage Patient Information Booklets
Facts You Need to Know About CustomVue™ Laser Assisted

In-Situ Keratomileusis (LASIK) Laser Treatment. Please read the patient information booklet completely. Discuss any questions with your doctor before you decide if CustomVue LASIK is right for you. Only an eye care professional trained in laser vision correction can determine whether you are a suitable candidate.

Patient Information Booklet for High Myopia (Nearsightedness)

Patient Information Booklet for Myopia (Nearsightedness)

Patient Information Booklet for Hyperopia (Farsightedness)

Patient Information Booklet for Mixed Astigmatism

Patient Information Sheet – VISX Wavefront-Guided LASIK for Correction of Myopic, Hyperopic, and Mixed Astigmatism