Patient Forms

We are currently following the CDC and AAO recommendations during COVID19.  Our Summit Office is open for urgent or emergent patients at this time.  If you have a future appointment with us please free complete the forms below.   Thank you and take care.

Below are patient forms for your upcoming visit with Ophthalmology Associates. You can complete the Patient Registration Forms online by clicking the button below.

Patient Registration Form (English)Patient Registration Form (Espanol)

If you prefer to print the registration forms and bring them with you on your visit, please print the HIPAA, Patient Financial Agreement and Medical History forms and have those completed when you arrive.

HIPAA and PRIVACY NOTICE ACKNOWLEDGEMENT ENGLISH VERSION

HIPAA AND PRIVACY NOTICE ACKNOWLEDGEMENT SPANISH VERSION

PATIENT FINANCIAL AGREEMENT 2019 ENGLISH

PATIENT FINANCIAL AGREEMENT 2019 SPANISH

Medical History Form

Medical History Form SPANISH

If you want a doctor to send your records to us use this form:

1 2019 Medical Records Request Incoming

If you want us to send your records to another doctor use this form:

1 2019 Medical Records Release Form Outgoing

Below are additional patient forms that you can print if you have a need for them.

Notice of Privacy Practices English

Notice of Privacy Practices Spanish

Notice of Privacy Practices English and Spanish Combined