Other forms can found below (Forms are in PDF format and require Adobe Reader):
Notice of Privacy Practices – All Patients
|This explains your rights under HIPAA, and how our office handles your privacy information. Required for all patients. This form is also available in Spanish.
|Financial and Office Policies
|This explains our practice’s financial and office policies for purchase of services and materials. Required for all patients. This form is also available in Spanish.
|Preventative Eye Health Screenings
|This explains how our practice uses technology to allow us to more efficiently diagnose and manage eye disease. Required for all patients. This form is also available in Spanish.
|Clean Practice Protocol
|This explains how our practice keeps our patients and staff safe during the COVID-19 pandemic. This form is also available in Spanish.
|This is the only form that patients need to bring to their exam. This form serves as the signature sheet for the previous 4 (blue-highlighted) forms. Simple bring this form printed and signed to your exam! This form is also available in Spanish.
|Patient History – All New Patients
|Your medical, eye health, and vision history. Required for all new patients.
|Amniotic Membrane Consent
|For those patients being treated with an amniotic membrane for dry eye, chemical injury, eye infection, etc.
|Cataract Surgery Consent
|For those patients who will be having cataract surgery post-operative care through our practice.
|Custom Contact Lens Policy
|For those patients being fit in custom contact lenses, gas permeable lenses, scleral lenses, SynergEyes, or other custom contact lenses.
|Extended Wear Contact Lens Consent
|For those patients that sleep in contact lenses, we ask that you complete this form.
|Medical, eye health, and vision history for patients aged 6-12 months of age.
|Punctal Plug Consent
|For those patients getting punctal plugs for dry eye treatment.
|Release of Liability
|Our mission is to prevent eye disease before it affects vision. Our doctors strongly encourage all patients to have their retinas imaged and/or have a dilated examination of their retinas. Should a patient decline both of those exams, we ask that this form be completed after having your questions or concerns about your eye exam discussed with a doctor.
|Dry eye questionnaire for patients being seen for an Ocular Surface Disease Exam (OSDE).
|Contributing Factors to MGD
|Systemic health questionnaire for patients being seen for an Ocular Surface Disease Exam (OSDE).
At Vista Eye Care, we pride ourselves in providing our patients with efficient, effective eye care. In order to provide our exceptional level of care for all of our patients, we have created a No Show Policy that applies to all patients who schedule appointments with us. Prior to your appointment, we will provide you with an email reminder, phone call reminder, and text message reminder. We understand that an unforeseen emergency, or changes in your schedule may occur, and we ask that you give us a 24-hour notice if you are unable to make it to your scheduled appointment in order to avoid a $25.00 cancellation fee.
If you have any questions about our Welcome Forms, Miscellaneous Forms, or Attendance Policy, or if you prefer to schedule your appointment by telephone, please don’t hesitate to call us at (303) 450-2020, or send us an email via our website.