Patient Forms

Thank you for taking the time to complete our forms prior to your visit to Vision Health Institute.

New Patient Forms:

Please fill out our electronic form (1) which will securely transmit your information directly to our office. If you prefer to print out the forms instead please complete form (2) & (3) and bring them to your first visit.

• (1) New Patient Digital Form – ELECTRONIC SUBMISSION
• OR
• (2) New Patient Form – PRINTING REQUIRED
• (3) Acknowledgement of Patient Privacy Practices  – PRINTING REQUIRED

Additional Forms:

• HIPPA Authorization to Release or Disclose Health Care Information [PDF]
• HIPPA Notice of Privacy Practices [PDF]
• iWellness and Digital Retinal Imaging[PDF]