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.

Patient Information Form / Assignment of Benefits
Please complete and bring to your appointment.

2020 Guide to Alleviate Digital Eye Strain
Download our free PDF here

Notice of Privacy Practices
Please review for your reference.