NEW PATIENT: HEALTH AND VISION HISTORY: Many systemic conditions can have signs or symptoms that affect your eyes. Therefore, our office requires a complete Health and Vision History so that we can better assess your ocular health. Once you are an established patient, we will review this form with you verbally at your annual visit(s).
PATIENT REGISTRATION FORM: This form is completed prior to your first visit and then every three years. Since this form requires e-signatures, if it is time for you to update your Patient Registration Form, we will forward that to you directly via secure email. If you prefer a printed copy, see below.
RECORDS RELEASE AUTHORIZATIONS: These forms provide authoriztion for your prior eye care provider to send your records to our office so we can better serve you.
|Records Release Authorization (FOR FIRST TIME PATIENTS OR TRANSFERRING PATIENTS)|
|File Size:||542 kb|
|Riverview EyeCare - Records Release Authorization (FIRST TIME PATIENT)|
|File Size:||150 kb|
HIPAA PRIVACY PRACTICES