Forms are available to print and fill out before appointment.
Please let us know ahead of time if you plan on filling out these forms prior to your appointment. Also, please be sure to bring your medical insurance card at the visit.
*NOTICE FOR HMO PATIENTS*
If you have acquired an HMO insurance, please be aware that it is YOUR RESPONSIBILITY as an HMO patient to confirm your eligibility (in-network) and the status of your REFERRAL, with your
Primary Care Physician (PCP)
If you DO NOT have a referral for the
date of service, you will be responsible for
We do NOT submit to any vision plans.
**ALL 5 FORMS ARE REQUIRED FOR YOUR INITIAL VISIT **
Printable PDF FORMS (non-fillable)
1. New Patient Intake
2. New Patient General Medical History
3. Office Policy 2021
4. Authorization Form for Parent/Legal Guardian
5. Notice of Privacy Practices
**WE DO NOT MAKE APPOINTMENTS OR DO CONSULTATIONS VIA EMAIL**
PLEASE CALL THE OFFICE (847) 256-2020