Patient Information

Patient Demographic Form
This form asks for personal demographic information and insurance information. We use it to complete insurance claim forms.

Medical History Questionnaire
This form asks some questions about past and current eye problems, and also about your general health. Many medical conditions and medications can affect the health of your eyes. By the same token, a look inside your eye can tell the doctor much about your general health! Please give us as much information as you can so that we can give you the best care possible.

Consent Form
This form allows us to treat your medical condition(s), and file insurance claims on your behalf. This form also instructs us regarding how to handle your personal health information, and advises you about some fees that are generally not covered by insurance.