Patient Forms

Patient Forms

Book Appointment

Online Forms

At Southwest Florida Eye Care, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

New Patient Health History Form – Required

Please complete these forms as they let us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

ACA – Translation Resources

Medications & Drug Allergies

Notice of Privacy Practices

Patient Acknowledgement and Authorization

Financial Agreement and Assignment of Benefits

Patient Info Medical History

Explanation of Coverage

Medical Records Release

Locations

We have three convenient locations in Southwest Florida. View the nearest location to you or get directions below.

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