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PATIENT HUB

FORMS

Attention:  Before registering for our Patient Portal, please contact us for the Practice ID and security code.

 

Please do not use the duplex, or double-sided, printing option when printing forms from our website.  Instead, please print one form per sheet of paper to ensure proper scanning of your forms on your appointment date. 

 

Additionally, on the date of your appointment, you may be asked by our staff to complete and sign our Billing Forms, including our Check-In Form and/or one of our waivers.  Thank you.

POLICIES

Notice of Privacy Practices

Updated February 2014

 

GENERAL PATIENT FORMS

For patients seeing our adult ophthalmologists or our optometrists.

 

 

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Medical History Form

Medical Records Request Form

New Patient Registration Form

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PEDIATRIC & STRABISMUS FORMS
For patients seeing Dr. Diora, Dr. Ellis, Dr. Jeffery, Dr. Morrison, or Dr. Torosian only
 

 

Medical History Form

Medical Records Request Form

Minor Consent Form

New Patient Registration Form

 

QUICK LINKS

ADDITIONAL RESOURCES

American Academy of Ophthalmology (AAO) Eye Smart (English)

 

American Academy of Ophthalmology (AAO) Eye Smart (Spanish)

 

American Association of Pediatric Ophthalmology and Strabismus  (AAPOS) Patient Information (Mutiple Languages)

 

You will need Adobe Reader to access our Forms.  To download this program, click here.

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