PATIENT FORMS

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If you are a new patient, please print and fill out these forms to bring to your visit.

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PRIVACY PRACTICES FORM >

PATIENT INFORMATION FORM >

PATIENT DISCLOSURES FORM >

SELF-PAY PATIENT DISCLAIMER FORM >

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DILATING EYEDROPS CONSENT FORM >

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E-MAIL PERMISSION FORM >

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FULL NEW PATIENT PACKET >

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 FULL RETURNING PATIENT PACKET > 

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HIPAA PRIVACY NOTICE >

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INSURANCE AND SELF PAY DISCLAIMER >

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MEDICAL RECORDS RELEASE FROM GCSF >

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MEDICAL RECORDS RELEASE TO GCSF >

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PATIENT WELCOME LETTER >

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PAYMENT AGREEMENT FORM >

 

REFRACTION SERVICES & FEES AGREEMENT >

 

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