Online Forms

Advanced Eyecare of Edgewater Online Forms

At Advanced Eyecare of Edgewater, we offer patient forms online so you can complete them in the convenience of your own home or office. Fax or email us your completed forms or bring them with you to your visit.

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Fax or email us your completed form(s) or bring them with you to your appointment.

Medical Record Release Form – “To Us” [PDF] In order for your provider to release your medical records to us – they will require a signed medical release form. You can use this form to request your medical records from your provider.

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Medical Release Form [PDF] If you would like us to release your medical records, you must first complete a medical release form. Under HIPAA regulations, this form must be signed by the patient. Completed forms can be mailed or faxed to our office.

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Advanced Eyecare of Edgewater Online Forms

Tear Film Evaluation

Patient Care

Financial Policy

Patient HIPAA Release Form

Medical Record Release Form – “To Us” [PDF] In order for your provider to release your medical records to us – they will require a signed medical release form. You can use this form to request your medical records from your provider.

Medical Release Form [PDF] If you would like us to release your medical records, you must first complete a medical release form. Under HIPAA regulations, this form must be signed by the patient. Completed forms can be mailed or faxed to our office.

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