For all NEW Patients, please complete and sign forms 1-5 listed below. You can complete and submit the forms below online by clicking the ONLINE button below each form.
Alternative option: Download and print the forms by clicking the PDF button for each form. Once completed, you can email the downloaded forms to the office at admin@visionaryretina.com or bring them with you to your appointment.
1. New Patient Information & Medical History Form
2. General Office Policies Form
3. General Consents Form
4. Release & Assignment of Benefits Form
5. HIPAA Acknowledgment Form
Note the HIPAA Policy can be found here: HIPAA Policy
Additional Forms if and when needed:
1. Authorization to Release Information to Designated Individuals
2. Authorization to Release Healthcare Information