Forms

Dear Patient:

Please complete the enclosed registration form and bring it with you to your scheduled appointment at our office. Do not mail or fax this form to our office prior to your visit.

You must bring your insurance card or cards to your office visit.

If your insurance plan has an office visit co-pay or does not cover refractions, please expect to pay for those at time of service.

If you have an insurance plan such as an HMO that requires a referral number, please verify with our office that the referral number has been received prior to your visit.

If you wear glasses or contact lenses please be sure to bring them with you for your office visit.

Please bring a list of any medications you are taking.

Please expect to be in our office one hour for a complete eye examination.

Thank you for your cooperation; we look forward to serving you.

Sincerely,
Eye Physicians of Austin, P.A.

• Patient Information Form
• Financial Policy Form
• Medical Records Release Form*
• Consent to Treat Minors Form

* NOTE: The Records Release form is only necessary if you are requesting a copy of your records.