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 (828) 623-0186 for assistance or click here to email us your questions.
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:
- HIPAA Form
- Financial Policy
- Medical Records Release
- Patient Health History Form
- Authorization of Examination, Treatment, Signature on File & Assignment of Benefits
- Retina Patients Demographic Sheet
- Amsler Grid
What you should bring to your new patient appointment:
- Plan to arrive 15 minutes prior to your scheduled appointment time.
- A valid/current copy of your insurance ID card is required at the time of your office visit. Please do not give us your cell phone with the picture of your card, we need a paper copy of the front and back of the card. If we are unable to verify your insurance information before you see the doctor, payment in full will be expected at the time of service.
- If your insurance requires an authorization for the visit, you must obtain this prior to arriving for your appointment.
- Completed patient information and medical history forms.
- A photo ID
- Forms of payment our offices accepts: Cash, Checks, Visa, Mastercard, Discover, American Express, and Care Credit.
