• Save time when visiting our office by filling all of your forms right here on our website! Please feel free to reach to us with any questions. We're here to help!

  • Patient Registration Form

    Please hit "Submit" at the bottom of the page! Please make sure to enter ALL information applicable to you.
  •  -
  •  
  •  
  • In case of emergency...
  •  -
  •  
  •  
  •  
  •  
  •  
  •  
  •  
  •  
  •  

  •  
  •  
  •  


  • Optomap Notice

    The Optomap Retinal Exam provides us with a scan of the retina to confirm the health of your eye and allows our doctors to detect the presence of disease early in its progression. Your Optomap image will be saved in your medical file enabling your doctor to make important comparisons during your annual eye exams. It may not require dilation drops which result in blurred vision and sensitivity to light for several hours. Some patients will need to have their eyes dilated also. The fee for the Optomap Retinal Exam is $39.00 and is not covered by your insurance. Our doctors recommend you have this test done at your annual exam.

  •  


  • HIPAA Notice

    This office is HIPAA compliant and the HIPAA policies and Notice of Privacy Practices are posted in the office and available to read.


  • Financial Policy

    We have contracts with many insurance companies to accept assignment of benefits for our services. Payment in full will be required unless insurance benefits to cover charges can be verified prior to rendering services. Your co-pay and deductibles will be collected at the time of your visit. We accept Cash, Check. Visa. Mastercard. Discover. American Express, and CareCredit. We will file your insurance claim and you wilt be billed for any amount not covered by the insurance company. Payment is due upon receipt of your statement.


  • Clear
  •  -  - Pick a Date
  • Should be Empty: