Patient Forms

/Patient Forms
Patient Forms 2019-03-21T09:30:02+00:00

New Patients

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.

Existing Patients

Patient Information

Click here to update your patient information online. Fill out only if information has changed; ie., address, phone, etc.

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

Medical History Update

Click here to download and print. Bring 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

By pre-submitting this information, you can avoid having to fill out forms upon your arrival.

Begin registration

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

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

Submit onlineDownload and print

We respect your privacy. Click here for our Privacy Policy.
Please use this form to request an appointment We will contact you to confirm and provide additional instruction.
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