Patient Info

PATIENT FORMSPatient Forms | Florida Eye Associates

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

Medical Information Release Form

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


  • 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


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

  • Health First
  • Aetna/PPO/HMO
  • Beech Street
  • Blue Cross Blue Shield – Not BCBS or Blue Select
  • Brevard Health Alliance (Dr. Parihar only)
  • Choice Care Network
  • Cigna
  • Comprehensive Health
  • Division of Blind
  • Employers Community Network
  • First Health
  • United Healthcare – Compass and Navigate (require authorization)
  • United Healthcare M Plus
  • GHI (Secondary)
  • Veteran’s Administration
  • Humana PPO Only
  • Medicare
  • Office of Disability
  • Multiplan (PPO Next, Prudential)
  • Project Response
  • Railroad Medicare
  • Secure Horizons
  • Tricare
  • Tricare For Life
  • Vocational Rehabilitation
  • Workers Compensation

Accepted Vision Plans:

  • VSP – signature only


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.

Tired of mailing in a check to pay your balance? We now offer the ability to pay online! Whether you are paying for your services at Florida Eye Associates, our Surgery Center or our Surgery Center Support Services you can now pay online. Click the corresponding button per your invoice. We accept Visa, MasterCard, Dicover, American Express.

Or we proudly accept CareCredit credit card to help pay down your invoice balance. Now you can use Pay My Provider, a new online payment solution from CareCredit, to help pay outstanding balances quickly and securely.


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 for details.
*Florida Eye Associates does not accept the 24 month no interest plan



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