Patient Forms

Please complete the forms below under [Necessary to Complete and Bring With You to Your Comprehensive/Yearly Exam] and review the information provided in [Information You Should Review Before Your Comprehensive/Yearly Exam]

These forms are necessary and must be completed before you arrive at our office, or we may have to reschedule your visit, as we are trying to completely eliminate waiting in our office.

These forms are for you to complete when coming for your annual/yearly comprehensive exam.

Necessary to Complete and Bring With You to Your Comprehensive/Yearly Exam

What’s new in our office: Please open this first [PDF]

Summary page and checkoff list: Please open this next [PDF]

Welcome to Our Office form [PDF]

Patient Information form [PDF]

Financial Policies form [PDF]

Household Family members form [PDF]

Medical Review of Body Systems form [PDF]

Information You Should Review Before Your Comprehensive/Yearly Exam

Refraction Explanation form [PDF]

Optomap® Retinal Exam Information form [PDF]

HIPPA Medical Information Release form [PDF]

HIPPA Notice of Privacy Practices form [PDF]

HIPPA Acknowledgement of NPP Received [PDF]