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simplify your visit

Carson City Optics Patient Forms

Filling out your forms ahead of time can help make your visit more comfortable. We offer digital forms so you can complete your information before you arrive. This helps our team prepare for your appointment and keeps your check-in process simple and efficient.

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FAST, SECURE, & PAPERLESS

Online Registration Hub

To provide the highest standard of medical eye care, we require all new and returning patients to update their information annually. Please have your insurance cards and a list of current medications ready before you begin.

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Please Present all Insurance Cards
Patient Name *
Today's Date *
Date of Birth *
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Sex *
Address *
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Emergency Contact Information and Authorization for Disclosure of Medical Information

I authorize The Optics Group to disclose my protected health information (PHI) and/or contact the following individual(s) in the event of an emergency or for purposes regarding my clinical care, billing, or appointment coordination:

Contact 1 Emergency Contact?
Contact 1 Authorized to make Medical Decisions?
Contact 2 Emergency Contact?
Contact 2 Authorized to make Medical Decisions?

The following section is required if you are not the primary insurance policyholder. Please complete all fields below.

Policy holder's Date of Birth
Policy holder's Address
Policy holder's Date of Birth
Policy holder's Address

Our Standard of Care policy is located at the bottom of this page.

By signing below, I acknowledge that I have read and understood the Standard of Care policy and the information above, and that I have had the opportunity to ask questions. 

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Date *

Standard Of Care

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WE’RE HERE TO HELP

Need Assistance?

If you have any trouble accessing the digital forms or have questions about our services, please call our Carson City eye clinic. We are happy to walk you through the process to ensure your visit is as seamless as possible.