New Patient Forms & Insurances Accepted



Ophthalmology Physicians & Surgeons offers our patient form online to help patients prepare for their upcoming appointments.

For all patients forms, click the indicated button to view and download the form. Patients are able to either type in information, print the form, and manually sign the form; or print the form and manually complete the form. In both cases, forms should be submitted to a member of our friendly staff once complete.



New Patient Forms:

All new patients should fill out the following forms. 



Medical History Form

SOF and PHI Disclosure


Additional Form for Medicare Patients:

If you are a new patient and have Medicare, please additionally fill out a Medicare Patient Form along with the standard new patient forms. 


Medicare Form



Insurance Information:

Commonly Accepted Insurances

For your convenience, OPS accepts a variety of insurance plans. Click on "View full list of companies" to see a list of commonly accepted insurances. This list is not entirely inclusive of all plans we accept and insurance eligibility may vary depending on the provider seen.

For specific insurance plan inquiries, please contact your insurance provider.


*Please advise, confirmation of insurance coverage and eligibility is the patient’s responsibility. The patient (or guarantor such as spouse, parent, etc.) is ultimately responsible for the charges incurred for tests and/or treatments received at our facilities.*

Aetna Better Health
Blue Cross
Capital Blue Cross
Golden Rule
Health Partners
Highmark Blue Cross Blue Shield
Keystone Health Plan
Keystone Health Plan East
Railroad Medicare
United Healthcare

Our staff is multi-lingual!
We are happy to assist you in the following languages:

• English• Spanish
• Korean• French
• German• Georgian
• Russian• Polish
• Portuguese• Filipino(Tagalog)
• Laos