Thank you for giving us the opportunity to provide you with superior, state-of-the-art surgical and medical eye care. In order to prepare for your upcoming appointment, please download and complete the "Health History Form" and the "Patient Information Form / Assignment of Benefits / Authorization for the Use or Disclosure of PHI." The "Notice of Privacy Practices" is also provided for your information. You only need to complete these forms if you are a new patient with Empire Eye and Laser Center.
Health History Form:
Please complete and bring to your appointment. Click to download a PDF (1 page).
Patient Information Form / Assignment of Benefits /
Authorization for the Use or Disclosure of PHI:
Please complete and bring to your appointment. Click to download a PDF (2 pages).
Notice of Privacy Practices:
Please review for your reference. Click to download a PDF (2 pages).
We hope that you will have a positive and memorable experience with us!
