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PATIENT FORMS

Download, Fill, and Return to Front Desk

HIPAA, INSURANCE, AND REFRACTION FORMS

Authorization for Release of Information, Statement of Patient Financial Responsibility, Insurance Authorization, Refraction Policy, No Show Policy

This form needs to be filled in addition to the information filled out at the patient portal

DEMOGRAPHICS AND MEDICAL QUESTIONNAIRE

This form does NOT need to be filled out if you have already completed this at the patient portal

NOTICE OF PRIVACY PRACTICES

This form is for patient reference only

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