Eye Clinic of Austin Patient Resources
Patient Registration
Below are helpful resources for our patients regarding accepted insurance plans, Patient Registration or update forms, and general information for our practice. Please print your completed form if you would like a copy for your records.
To download a form to your computer, just right click on the link and select "Save Link As....." to begin downloading. Download a copy of Adobe Acrobat if you do not already have one to print out the patient forms. Some PDF security features may not run in older versions and an update may be needed.
General Information
Notice of Privacy PracticesPatient Registration Forms
The Eye Clinic of Austin uses a specialized practice management software program. We ask every patient to participate in maintaining the following:
- Reviewing registration information
- Providing current insurance cards (Required at every visit)
- Providing drivers license or state issued identification (Required at every visit)
- Allowing us to capture your photo for your account and chart (so the doctor can identify your electronic medical record)
Below are our registration forms divided by new and established patients. Patients are encouraged to complete and print these forms prior to arrival at our office. Be sure to bring your insurance card and identification with you.
We have added a complimentary Patient Medication Log for your convenience. Feel free to use this form with your other doctors or keep handy in the event of an emergency.
Patient Medication LogNEW PATIENTS
A new patient is one who has not received any professional services from our providers within the past three (3) years.
New Patient Medical HistoryESTABLISHED PATIENTS
An established patient is one who has received professional services from our providers within the past three (3) years.
Patient Annual Medical HistoryProof of Insurance
If you cannot provide proof of insurance on the day of your visit we will require you to read and agree by signing the following policy:
Proof of Insurance WaiverManaged Care Plans (HMO, MC, POS)
If you have a managed care insurance plan you may be required to provide our office with a referral and/or authorization to visit our doctors. If you do not have a referral/authorization we will require you to read and agree by signing the following policy:
Unauthorized Visit WaiverMedical Records Requests
To request the Eye Clinic of Austin to send a copy of your medical record to another person or place, please complete the following form and submit to our medical record department.
Request Eye Clinic of Austin to Release Information to Another PartyTo request another person or place to send a copy of your medical record to Eye Clinic of Austin, please complete the following form and submit to the doctor or entity, or send it to our medical record department and we will submit it for you.
Request Release of Medical Information to Eye Clinic of Austin