Patient Forms

/Patient Forms
Patient Forms 2021-01-18T14:25:51-05:00

Patient Registration

Patient Information and Medical History

Click here to complete your patient information and medical history online. The information will be waiting at the office.

*Please use an updated version of Chrome, Firefox or Edge (Internet Explorer). Some users may experience issues using Safari.

In the alternative, Click here to download and print the patient information and medical history form. Bring them with you to your appointment.

Authorization to Receive/Release Health Information (HIPAA)

Click here to submit online | Click here to download and print
This form is mandatory due to the HIPAA Compliance Privacy Laws of the Federal Government.

Refraction Letter

Click here to read and complete your refraction form if you do not have vision insurance. Print and bring with you to your appointment.

Questions?

If you have any questions or need to reschedule/cancel your appointment, call 770-979-2020 (option 1).

Quick Links

If your records will be transferred from another doctor, please complete the ‘Medical Records Transfer Authorization’ prior to your visit.

Submit onlineDownload and print

Due to the HIPAA Compliance Privacy Laws of the federal government, it is mandatory that we ask you to review and answer these questions.

Submit online  |  Download and print

We respect your privacy. Click here for our Privacy Policy.
How did we do? Please tell us by completing our Patient Satisfaction Survey!
Refill your contact lens prescription online! Re-order Contacts

Please use this form to request an appointment This is only a request. We will contact you to schedule an appointment.

Click here to access the Patient Portal.

Payment Options

Apply for Financing via CareCreditCredit card logos