Forms

Patient Forms

In Preparation for Your Visit

Notice of Privacy Practices (Please Read)

Patient Financial Responsibilities (Please Read)

Medical Records Release Form

New Patients

Health History Questionnaire

New Patient Registration

HIPAA

Retina Surgery Center

To fill out and submit New Patient forms electronically please click here.

Admission Policy

Surgery Center Charity Care Policy

Surgery Center Charity Care Application

Upcoming Surgery Patient Packet

Referring Doctors

Referral Pad