Central New York Eye Center

 

ReSTOR Crystalens LASIK
Patient Forms
 

In order to provide our patients ultimate convenience and save you waiting room time, we have uploaded our New Patient Intake forms. Please take a moment to print these out and bring them with you for your examination. You will need Adobe Acrobat Reader in order to view and print them. If you require Adobe please click on the following link to download: http://www.adobe.com

Insurance Authorization Form (1 page)  All patients will need to sign this form regardless of insurance type.

HIPPA Privacy Form (1 page) Agreement to Protected Health Information.

Medical History Form (3 pages) All patients will need to complete this questionnaire.

 New Patient Intake Form (1 page) All patients will need to complete this information.

 

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