Patient Forms
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 850.474.8436 for assistance. 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
New Patient Packet:
Please click on the link below to download and print your packet:
General Forms:
- Lifetime Insurance Assignment and Authorization Form
- Notice of Health Information Privacy Practices
- Amsler Grid (Home Test for Macular Degeneration)
Patient Satisfaction Survey
We appreciate you choosing Eye Institute at The Medical Center Clinic as your eye care provider. How you feel about the care you received during your visit is important to us. Please follow the link below to take our Patient Satisfaction Survey and tell us how we did.
Vision Correction Provider Checklist
The decision to have laser or surgical vision correction is an important one that you should make carefully, not quickly. Choose a practice that focuses on safety, diagnostic technology, post-operative follow-up. Obviously, the experience of the surgeon is extremely important as well. We hope you will choose Eye Institute at the Medical Center Clinic as your provider, but if you’re shopping around, use this checklist to compare.
Please fax any forms to 850.474.8285 or send them using the form on this page.
