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Patient Information


Patient Registration

To minimize your wait time, you may pre-register with our office by completing your profile and health history through our secure patient portal.

 Please use the following link to access the patient portal.



 First Initial + Last Name + 4 digit year of birth

 You will be prompted to verify your information and then to create a new password.

If you are unable to complete our online process, please print the forms below, complete and bring them with you to your appointment.


For our patients who are under nursing home care or have a caregiver at home, we recommend someone accompany them to all medical appointments. We feel the caregiver should hear what the doctor has to say first-hand to avoid confusion or misinterpretation of treatment. 

Medical History Questionnaire

Consent for Medical Treatment, Release of Information

Acknowledgement of Receipt of Notice of Privacy Practices

Financial Policy


Patient Referral Form 

Good Faith Billing 


First Visit

When you schedule your first appointment with our talented team of eye doctors here at Eye Surgeons Associates, you’ve taken the first step towards ensuring that your eyes stay healthy and your sight clear.  We are dedicated to providing the best possible care to our patients, so your first appointment is dedicated to gathering the necessary information to create a personalized treatment plan based on your needs.

Assessing Your Vision

Your first visit will last from one to two hours, approximately, although times may vary for each individual case.  When you first visit our office, you will be greeted by our friendly staff and they will perform a health history and a variety of ocular tests to get a complete understanding of your eye health.  You will then be examined by one of our ophthalmologists to determine what kind of care you need and plan the next steps in your treatment process.

Pupil Dilation

In order to get the best possible view inside of your eye, we may be required to dilate your pupils using specialized eye drops. Once your pupils are dilated and the examination is finished, you eyes will be extremely sensitive to light, and may distort your vision slightly. These effects will wear off in a few hours, but you should plan to bring sunglasses or a wide-brimmed hat to protect your eyes from the sun when you leave.  You may also want to bring someone to the appointment in order to drive you home but it’s not required.

What to Bring with You

In addition to eye protection, you should also bring a list of current medications (including any over the counter medications and supplements) that you are currently taking, all of your insurance information and a picture ID.  If you wear glasses or contact lenses, please bring your current set to the appointment. The more information we have, the easier it will be to put together the perfect eye care plan for you. Also, you may wish to bring a list of any questions or concerns you may have, which we will happily answer.

Please bring all of your insurance cards and your ID with you to your appointment.  Thank you!

We accept most major insurance plans including Aetna, BCBS, Blue Care Network, Medicare, Medicare Plus Blue, Medicaid, HAP, Humana, Molina, Meridian, BC Complete, Trinity Health, and United Healthcare.

Schedule Your Appointment Today!

Here at Eye Surgeons Associates, we believe that great care begins with great communication. Whether you are receiving corrective lenses or preparing for eye surgery, our ophthalmologists will speak clearly and candidly with you concerning the diagnosis, your treatment options and our recommendations.  As one of the top eye care providers for patients we’re ready to help you preserve your vision, so contact us and schedule an appointment today!

Appointments/Cancellation/No Show Policy

Your scheduled appointment time has been reserved specifically for you. We are aware that unforeseen events sometimes require missing an appointment. We require a 24-hour advance notice to cancel your appointment. We charge a $40.00 missed appointment fee if your appointment is cancelled with less than the 24-hours advance notice. This fee is not covered by insurance.

Our Locations

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