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

ONLINE PDF

2. General Office Policies Form

ONLINE PDF

3. General Consents Form

ONLINE PDF

4. Release & Assignment of Benefits Form

ONLINE PDF

5. HIPAA Acknowledgment Form

ONLINE  PDF

Note the HIPAA Policy can be found here: HIPAA Policy

Additional Forms if and when needed:

1. Authorization to Release Information to Designated Individuals

ONLINE PDF

2. Authorization to Release Healthcare Information

ONLINE PDF