Patient Forms

Thank you for choosing Eye Centers of Florida!

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:

Patient Registration Form

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.

Download English Patient Registration Form
Download Spanish Patient Registration Form
Download Creole Patient Registration Form

Patient 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.

Download English Medical History Form
Download Spanish Medical History Form
Download Creole Medical History Form

Medical Records Form

Completion of this form will allow us to release your medical records.

Download English Medical Records Form
Download Spanish Medical Records Form
Download Creole Medical Records Form

Parental Consent Form

Completion of this form will allows a parent, custodian, or guardian to authorize diagnosis, treatment, or care for a minor.

Download Parental Consent Form

Maintenance and Return Policy

Maintenance, warranty, and return policy for eyeglass frames and lenses.

Download Maintenance and Return Policy

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