Please remember to fill out tabs: DEMOGRAPHICS, MEDICAL HISTORY, MEDICAL INSURANCE, and VISION PLAN before you click the gray “submit data” box in the submit data tab. If you do not have medical insurance and/or a vision plan, select “none”.
If you need records sent to us, please print the “Records Release”, fill it out and fax it to your previous or referring doctor.
All patients must consent to our privacy practices. You will be asked to sign a consent form when you arrive for your appointment. In order to review our privacy practices, please click on the “Statement of Privacy Practices – HIPAA” link. There is no need to print this.