Patient Info

PATIENT FORMS

Before your first visit, please click on the appropriate form(s) below, print and fill out completely to ensure that you are seen as quickly as possible when you arrive.
Thank you. 

Patient Forms

• Patient Registration Form 
• Medical History Questionnaire

Medical Information Release Form

• Authorization to Release / Obtain Health Information

At Florida Eye Associates, your privacy is important to us. Before your first visit, please click on the Notice of Privacy Practices Form below to view our privacy practices. Print and fill out the Notice of Privacy Practices Acknowledgement Form to ensure that you are seen as quickly as possible. Thank you.

Privacy Policy Forms

• • Notice of Privacy Practices
  • Notice of Nondiscrimination 
• Notice of Privacy Practices Acknowledgement Form

WHAT TO EXPECT

• VF-Visual Field 30 minutes
• OCT-Optical Coherence Tomography (patient may be dilated) 15 minutes
• Photos (dilated) 30 minutes
• Refraction (dilated) 30 minutes
• LASIK testing (dilated) 2 hours
• Glaucoma testing (dilated)2 hours

ACCEPTED MEDICAL INSURANCES

A partial list of accepted medical insurances – call to confirm we accept yours

• Aetna/PPO/HMO
• Blue Cross Blue Shield
• Cigna
• Division of Blind
• GEHA
• GHI (Secondary)
• Health First
• Humana PPO Only
• Medicare
• Multiplan (PHCS, PPO Next, Prudential)
• Railroad Medicare
• Tricare
• Tricare For Life
• United Healthcare – Compass, Navigate and MMA (require authorization)
• Veteran’s Administration
• Vocational Rehabilitation
• Workers Compensation

PAYMENT OPTIONS

Florida Eye Associates accepts most insurances. Patient payments and co-pays may be made in cash, check or most major credit cards. Payment is due at the time of service.

Ambulatory Surgery Center Support

ASC of Brevard

Florida Eye Associates

CARECREDIT PAYMENT OPTIONS

Ambulatory Surgery Center

ASC of Brevard

Florida Eye Associates

FINANCING OPTIONS

Florida Eye proudly offers financing options with approved credit through CareCredit and Wells Fargo for your healthcare financing needs. Choose the finance company that works best for your needs!

Get the Care You Want, When You Need It.

Help pay for your family’s vision care with the CareCredit healthcare card. Use your credit card to pay for:

• Glasses and sunglasses
• Contact lenses
• LASIK, Cataract Surgery
• Cosmetic Procedures And more

CareCredit is the healthcare credit card designed exclusively for healthcare services with special financing options.* Whether it’s a routine checkup or a LASIK procedure, you shouldn’t have to worry about how to get the best eye care.

With CareCredit you can choose to reserve your cash and free up your general-purpose credit cards for other expenses. Once you have CareCredit, you can use it as often as you want, without reapplying, as long as you have available credit. CareCredit is accepted at more than 200,000 providers nationwide.

*Subject to credit approval. Minimum monthly payments required. Visit www.carecredit.com for details.
*Florida Eye Associates does not accept the 24 month no interest plan

EYE HEALTH LINKS

Click on the links below for more information regarding eye health:

• American Academy of Ophthalmology
• Medicare Insurance
• National Eye Institute
• American Macular Degeneration Foundation
• American Foundation for the Blind
• American Glaucoma Society
• Lighthouse International
• Resource Guide for the Blind

MAPS

Click Here to view our printable maps