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.

Notice of Privacy Practices
Please review for your reference.