This is your place for important forms, from new patient registration forms to our privacy policy and program enrollment forms. If you have any questions while filling out your forms, don’t hesitate to contact us for assistance.
New Patient Form
Pleasefill out this patient data sheet so that we may better understand your general health and visual condition.
HIPPA Privacy Form
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Lifestyle Index
This questionnaire is meant to help your doctor understand what you're experiencing on a regular basis - whether it's caused by your eyes, posture, stress, etc. Your responses will help make sure you receive the best care possible.
Optomap
Dr. Rice and Dr. Galloway recommend the Optomap Retinal Imaging. It is a 3-D image of the back of the eye (the Retina) and is painless, non-invasive, with no side effects.
