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.  All our forms can be printed and saved to your personal computer.

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.

General Information

• Notice of Privacy Practices - HIPAA
• Notice about Disclosing Insurance
• Insurance Plans Accepted 

Patient Registration Forms

The Eye Clinic of Austin has implemented a new software program.  We will be asking every patient to participate by:

• Reviewing their registration information;
• Providing all insurance cards;
• Providing your drivers license (for check & credit card ID purposes);
• Taking your photo for your account (so the doctor can identify your electronic record)

Below are our new registration forms divided by new and established patients.  Patients are encouraged to print and complete these forms prior to your arrival at the office.  Be sure to bring your insurance cards and drivers license with you.

NEW! - We have added a Patient Medication Log for your convenience.  This form can also be completed, printed and saved on your own computer.  Feel free to use this form with other other providers or keep handy in the event of an emergency.

Patient Medication Log

New Patients

A new patient is one who has not received any professional services from our providers within the past three (3) years.

• Patient Registration Form - English
• Patient Registration Form - Spanish
• Patient Acknowledgement & Disclosure Form 
• New Patient Medical History Form 
• Tricare Patient Refraction Waiver (Tricare Patients ONLY)
• Patient Refraction Policy Acknowlegement (Not for Tricare Patients) 
• OptoMap Service - Elect or Decline Form (Routine Vision Exams only)

Established Patients

An established patient is one who has received professional services from our providers within the past three (3) years.

• Patient Annual Medical History Form   (Required Annually by the doctor)
• Patient Registration Form - English (If you have a change in address, phone, etc.)
• Patient Registration Form - Spanish (If you have a change in address, phone, etc.)
• Tricare Patient Refraction Waiver (Tricare Patients ONLY)
• Patient Refraction Policy Acknowlegement  (Not for Tricare Patients)
• Optomap Service - Elect or Decline Form (Routine Vision Exams only)

Medical Records Request Forms

• Request Records From Eye Clinic of Austin
• Request Records be sent to Eye Clinic of Austin

Contact Lens Information / Forms

• Patient Contact Lens Fitting Agreement Form