Gulf Coast Eye Care

Patient Forms

For your convenience, new patient forms are available to you online. By completing the forms prior to your arrival for your scheduled appointment, this may save you time in our office.

Please complete the following forms in our Patient Registration packet prior to your appointment:

  • Registration Form
  • Medical History
  • Authorization to Receive and Release Health Information
  • Notification of Refraction and Refraction Fee
  • Financial Agreement and Lifetime Signature Authorization

Download Patient Registration packet

  • Lifestyle Questionnaire
    If you are being evaluated for cataract or lens replacement or vision correction surgery, please complete this short questionnaire and bring it with you to help us get a better understanding of how you use your eyes day to day. Thank you.
  • Notice of Privacy Practices
    Please retain a copy of this form for your records. Thank you.
  • Medical Records Request Form
    In order for your other providers to provide your medical information to Gulfcoast Eye Care, please fill out the Medical Records Request Form.
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Gulf Coast Eye Care

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