For your convenience, we have made a number of forms available for patients to download. If you are new to our practice, we encourage you to download and print out the new patient forms. Filling these out in advance of your first visit will minimize the time you spend in the waiting room filling them out when you get here. Other forms are informational. If your doctor has given you a form with specific information or instructions different from the information on these online forms, rely on the information given to you by your doctor, not on the online forms. If you're not sure which forms you need, please call 850-474-8209 for assistance or email us your questions at Kimberly.grant@medicalcenterclinic.com.
If you're unable to open these files, you probably need to download the free Adobe Acrobat Reader program, which is available at the following location: www.adobe.com/products/acrobat/readstep.html
Click on the forms you would like to download:
- Notice of Privacy Practices
- Lifetime Insurance Assignment and Authorization Form
- Protected Health Information
- Ophthalmology History Form- Dr. Eddington-Reese
- Ophthalmology History Form- Functional Impairment Survey
- Ophthalmology History Form- Dr. Murray
- Ophthalmology History Form- Dr. Suelflow, Dr. Aldred, Dr. Stillman, Dr. Rowland and Dr. McLaughlin
- Laser Vision Correction Procedures Frequently Asked Questions
- Laser Vision Provider Checklist
- Amsler Grid (Home Test for Macular Degeneration)
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