Thank you for choosing Eye Centers of Florida!
For your convenience we have introduced the Clearwave self-service registration system in our Fort Myers office to increase accuracy and reduce delays. This means you will receive an email and/or text message to help you check in to your next appointment.
Your first encounter with Clearwave may take a few minutes to complete but after the first time it will only take a minute or less to verify your information is correct and check in to your appointment.
For a faster check in experience, please complete your first Clearwave encounter before your appointment on your computer or mobile device, following the instructions on the email or text message.
Thank you for your patience as we introduce this exciting new system!
The forms included in this registration packet enable us to learn about your health and how it affects your vision, understand your overall health, track the effectiveness of your treatment, and accurately bill your insurance.
We realize filling out paperwork for healthcare in today’s world is time consuming. We have made every effort to minimize the paperwork required for our patients, while also getting the information we need to provide you with the highest quality service possible.
The following forms are included:
#1 – Patient Registration
All new patients must complete this form. Existing patients may need to update information. Please bring your insurance card(s) to your first visit, as we will need photocopies for our records.
#2 – Patient Initial Questionnaire and Medical History Form
Your answers on this form will allow us to have an accurate picture of your current physical condition and is valuable for a thorough evaluation by your doctor.
#3 – Patient Visual Function Form
Completion of this form will give us a better understanding of your current visual acuity.
#4 – Medical Records Form
Completion of this form will allow us to release your medical records.
#5 – Parental Consent Form
Completion of this form will allows a parent, custodian, or guardian to authorize diagnosis, treatment, or care for a minor.
#6 – Maintenance and Return Policy
Maintenance, warranty, and return policy for eyeglass frames and lenses.
Please contact the clinic where you have scheduled your appointment directly if you have questions. As a reminder, be sure to bring your insurance card and any co-payment that you may be required to make to the visit. We accept cash, personal checks, and bankcards and can arrange for financing.