Patient Forms

New Patient Forms

If you’re a new patient, please download, print, and fill out these forms before you come to the office. This will save time and help the doctor see you promptly.

  1. Patient Demographic Form
  2. Patient Insurance Form
  3. Patient Assignment of Benefits
  4. HIPAA Consent:  Please read HIPAA Information prior to signing
  5. ***HIPAA Information Sheet***

Cataract surgery

If you’re considering cataract surgery with us, look no further! For your convenience, please download and review the Cataract Information Packet for helpful information about options for your surgery; then simply download, print and fill out the Pre-Surgical Questionnaire before you come to the office for your appointment.

Referring Physician Form

Release of Medical Records

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(907) 328-2920


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Fairbanks, AK

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Hours
Monday: 7:30am – 6:00pm
Tuesday: 7:30am – 6:00pm
Wednesday: 7:30am – 6:00pm
Thursday: 7:30am – 6:00pm
Friday: 7:30am – 6:00pm
Saturday: 9:00am – 4:00pm

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