Forms
Registration Form
Patient Summary
Health Questionnaire
Release of Records From Our Office
Release of Records To Our Office

FAQ

Locations & Directions

Referring Physicians

All forms are in PDF format and
require Adobe Acrobat Reader.

Forms

If you are a new patient and would like to complete most of your paperwork before the day of your visit, please complete the following documents
New Patient Registration Form (PDF)
New Patient Health Summary (PDF)
New Patient Health Questionnaire (PDF)

Medical Records Release
If you desire for your medical records to be sent to another physician, please complete a medical records release form and fax it to us at (614) 221-8117. It may take up to 10-14 days to process your request once we have received it.
Requesting Records To Be Sent From Our Office (PDF)
Requesting Records To Be Sent To Our Office (PDF)

Consent for Medical Treatment
We must have consent in order to treat our patients.  You will be able to review and sign this consent at your appointment.  If our patient is younger than 18 years of age, a parent or legal guardian must sign the consent for them.  This is especially necessary if the patient is brought to our office by someone other than a parent or legal guardian.

If the patient is in the custody of a non-parent, we must have a copy of the guardianship agreement before the patient can be seen at our office.

Ophthalmic Surgeons' Privacy Policy
We respect your privacy.  Our privacy policy will be able to be reviewed at your appointment..  Please feel free to contact us with any questions.