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.

Financing Available by Wells Fargo Financial National Bank with approved credit. Click Here to Apply


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


Click Here to view our printable maps