the eye institute of west florida

Patient Forms

Patient Paperwork

Woman filling out Patient Forms

Before your first visit, you will be given forms to complete. Your vital medical history along with other information will help our physicians and office provide the best care possible. We will also attempt to secure copies of your previous ophthalmic medical records.

Please arrive 15 minutes early to your first appointment at The Eye Institute of West Florida.

Below are our Patient History and Registration Form and our Health Insurance Portability and Accountability Act (HIPAA) Information and Consent Form, which will need to be completed prior to your first appointment with us. Our Medical Records release form is also available, should you need a complete history of your ophthalmic medical records. You can print these forms out and bring them in completed to your appointment.

Patient History and Registration Form – English

Patient History and Registration Form – Spanish

Health Insurance Portability and Accountability Act Information and Consent Form

Medical Records Release Form

Online Patient Paperwork:

If you wish to fill out your patient paperwork digitally, please send a request to appointments@eyespecialist.com with your name, date of birth and your delivery preference (text or email).

Missed Appointment and Cancellation Policy Notice:

*Please note you will incur a $25 fee if you are unable to make your appointment without giving at least 24 hours prior notice. You will incur a $150 fee if you are unable to make your surgery appointment without giving at least 48 hours prior notice.

Non Discrimination Policy Notice:

Nondiscrimination Policy

LASIK Self-Test Cataract Self-Test