New Patients
Please fill out the following patient information forms and bring them with you to your first visit. Signing "Acknowledgement of Receipt of Privacy Practices" on the form signifies that you have read the Notice of Patient Privacy Practices. Thank you!
| arbor_eyecare_hipaa.pdf |
| new_patient_symptom_questionnaire.pdf |
Established Patients
Please print and complete these forms prior to your visit, even if you have completed them at a previous visit. When you bring the completed forms with you, you help us maintain social distancing. Thank you!
| arbor_eyecare_hipaa.pdf |
| established_patient_symptom_questionnaire.pdf |
Records Release
Please complete and sign this form if you would like us to either release your records to a third party or would like us to request your eye care records from another practice.
| records_release_form__2021.05__1_.pdf |
Authorization for treatment of a minor (17 years old or younger) patient
If you would like to authorize care for a minor when you are not able to be present in clinic, please complete the following form.
| consenttotreatminor_2021.05.pdf |
Patient Portal
Our practice is now online. Access all of your records or message our office anytime, day or night. If you haven't logged in previously, please contact our office to obtain your username and password. You can find more details about the patient portal in the information sheet below.
| patient_portal_access.pdf |
Dilation Waiver
Please print, sign and bring to your appointment if you prefer to not be dilated at your appointment.
| dilation_waiver_2021.05.pdf |
Forms for Preop Appointments
Please print, fill out and bring to your preop appointment, this will help expedite your check in process.
Please print, fill out and bring to your preop appointment, this will help expedite your check in process.
| ros_preop_lasik-prk_2020.03.31.pdf |
| ros_preop_cataract-rle_2020.03.13.pdf |
| vision_lifestyle_questionnaire_2021.05.pdf |