• Florida Eye Associates Florida Eye Associates

  • Call for a consultation 321-727-2020

    Fax 321-726-4061

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 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


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


Ambulatory Surgery Center

ASC of Brevard

Florida Eye Associates


Florida Eye proudly offers financing options with approved credit through CareCredit 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


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


Click Here to view our printable maps


Would you like ongoing insights about eye health from us?

Simply opt-in for our EYE INSIGHTS newsletter emailed to you every quarter.



Email Opt In
Florida Eye Associates Questions