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***
6. (Optional) Verbal HIPAA Release Authorization

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.

• Cataract Information Packet
• Pre-Surgical Cataract Questionnaire

Referring Physician Form

• Patient Referral Form

Release of Medical Records

• Medical Records Release Authorization: send records to MVEC
• Medical Records Release Authorization: get records from MVEC