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eye clinic of austin patient forms

Existing Patient Forms

Below are our existing patient forms for registration, medical history, Optomap service, and more. Simply click the link and the PDF download should begin. An existing patient is a patient who has received professional services from Eye Clinic of Austin within the past three years.

Patient Annual Medical History

Patient Registration – English

Patient Registration – Spanish

Patient Authorization Form

Authorization for Use or Disclosure of Medical Record Information

Tricare Patient Refraction Waiver (Tricare patients only)

Optomap Service – Elect or Decline (Routine vision exams only) Adult

Optomap Service – Elect or Decline (Routine vision exams only) Pediatric

 

Dry Eye & Refractive Surgery (LASIK/PRK) Forms

If you are coming in for a dry eye assessment or LASIK consultation, please download the respective form below, fill out, and bring in to your appointment.

Refractive Surgery Questionnaire

Dry Eye Questionnaire