Patient Paperwork
Before your first visit, you will mailed or given online access to standard forms to complete. Your vital medical history along with other information will help our physicians and office provide the best care possible. We will also attempt to secure copies of your previous ophthalmic medical records.
If you did not fill out your new patient paperwork beforehand, please arrive 15 minutes early to your first appointment to fill out the necessary forms.
Printed Patient Paperwork:
Below are our Patient History and Registration Form and our Health Insurance Portability and Accountability Act (HIPAA) Information and Consent Form, which will need to be completed prior to your first appointment with us. Our Medical Records release form is also available, should you need a complete history of your ophthalmic medical records. You can print these forms out and bring them in completed to your appointment.
Online Patient Paperwork:
If you wish to fill out your patient paperwork digitally, please send a request to appointments@eyespecialist.com with your name, date of birth and your delivery preference (text or email). You will be given instructions on how to create an account with our Patient Portal (MyPatient Visit) to access and fill out your new patient paperwork prior to your appointment.
Missed Appointment and Cancellation Policy Notice:
*Please note you will incur a $25 fee if you are unable to make your appointment without giving at least 24 hours prior notice. You will incur a $150 fee if you are unable to make your surgery appointment without giving at least 48 hours prior notice.
Non Discrimination Policy Notice:
Notice of Privacy Practices:
Notice of Privacy Practices PDF
Patient Paperwork FAQs
Here you will find answers to your FAQs (frequently asked questions) regarding our new patient paperwork.
Patient Paperwork (5)
- You can come to your appointment 15 minutes early and fill out the necessary paperwork.
- You can print out the new patient paperwork off our website and fill it out beforehand to bring to your appointment.
- Patient History and Registration Form – English
- Patient History and Registration Form – Spanish
- Health Insurance Portability and Accountability Act Information and Consent Form
When establishing yourself as a new patient, there are various standard forms that need to be filled out completely before your appointment. These forms include the following:
- Patient Demographics: includes important details about you including your address, contact information, date of birth, employer information, etc.
- Medical History: includes your current medications, allergies, past eye medical and eye history, surgical history, and family history.
- HIPAA Information and Consent: this document gives your designees permission to be notified of and have access to your Protected Health Information (PHI).
- Patient’s Rights and Responsibilities: this document outlines the expectations we have of and what you rights are as a patient of The Eye Institute of West Florida.
- Medicare Authorization: this document authorizes us to bill Medicare and Medicaid (when applicable) for rendered services.
- No-Show/Cancellation Policy: this document outlines our policy in regards to patient’s not showing and cancelling appointments.
- Arbitration Agreement: this document informs you of an available dispute resolution process between The Eye Institute of West Florida and the patient.
- Consent, Assignment of Benefits, and Financial Agreement: this document informs you that we will bill your insurance(s) for services rendered.
Upon scheduling your appointment with us, you will be asked how you want to receive your new patient paperwork. If you opted to receive it digitally (online), you will either have it emailed or texted to you. This process typically occurs within 1 (one) hour. You will receive a message with a link to create an account with the Patient Portal (MyPatient Visit). Once you register, your forms will be available in your account.
From the top menu, click or tap “myDocuments” and the select the “Forms” option from the menu drop-down. This section will house all of your outstanding forms. Just click or tap the form to get started. Note that at any time you can click the “Save for Later” option. This allows you to stop the process and go back to resume at a later date/time. Once you have completed all the required questions, click the “Submit” button to send the paperwork to your electronic medical record.
If you are having trouble setting up an account or need an account creation link sent to you, please call (727) 581-8706 or email appointments@eyespecialist.com with your and date of birth.
If you are a new patient to our practice (or have not been seen in 3 years) you will be asked how you want to receive your new patient paperwork. Your choices are mailed or sent digitally (via text message or email). If you requested your patient paperwork be sent digitally, please create an account for the Patient Portal (My Patient Visit) within 72 hours of receiving the link. MyPatient Visit will have the required forms for you to fill out.
Yes. If you have not filled out your new patient paperwork prior to your appointment, we request you come in 15 minutes early to fill it out. If you complete your new patient paperwork digitally or filled out the paper copies that were mailed to you, you can arrive just a few minutes before your appointment.
