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

Click on the links below to download required forms.

Patient Registration Form

Financial Agreement Form

Medical History Questionnaire

Medical Information Release Form

Consent For Treatment of Minors

ASC Ophthalmology Authority to Release Information

Dr. Weiser Video Consent Form (English)

Dr. Weiser Video Consent Form (Spanish)

Privacy Policy Forms

Click on the links below to download required forms.

Notice of Privacy Practices

Notice of Nondiscrimination

Notice of Privacy Practices Acknowledgement 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.