Important Announcement: We've partnered with ReFocus Eye Health to best focus on providing the best patient care possible. Of course, our doctors and staff will remain the same but our name, logo, and website will be updated as we integrate with the ReFocus family of eye clinics. This will not affect your appointments or your patient experience in the least. 

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Patient Forms


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

Signature on File

HIPAA Consent

Patient Provider Release


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