Please fill out the following patient information forms and bring them with you to your first visit. Signing "Acknowledgment of Receipt of Privacy Practices" on the form signifies that you have read the Privacy Policy, listed below.

Patient Health History

• ​Patient health history

​​health.pdf
Patient Information Sheet

• Patient demographics and insurance information​

​pt._info..pdf
​HIPAA Policy

• ​Our office HIPAA policy.  Please sign and a copy will be returned to you following the exam. 

Office Visit Checklist

• This form will remind you what you need to bring with you for your visit​

​optos5.pdf

• ​We offer a very high tech way of assessing the health of the retina.  These tests digitally photo the retina and allow the doctor to look for disease on a cellular layer.  These tests are optional and are highly recommended.  Should you have any questions regarding them, the Doctor and Staff are available to explain.

[NOTE: This PDF requires a free plugin that may have come included with your browser. If you are having difficulties opening this file Click Here to go to Adobe's web site for Acrobat Reader.]

---

Online Forms: