These forms are best viewed with Adobe Acrobat Reader, which can be downloaded for free on their website at http://www.adobe.com/.
ENTRANCE/HEALTH HISTORY FORM - For your convenience, you may download our Entrance/Health History form that we give to each new patient upon arrival to our office. Please print and complete this form prior to your visit and bring it with you at the time of your appointment. If it is your first time to our office, you will also need to bring a copy of the Privacy Consent form listed below.
MEDICAL RELEASE FORM - This form is used if you would like to authorize Ganly Vision Care to release your records to third parties. You may simply complete the form and fax it to our office.
PRIVACY CONSENT - In regards to HIPPA (the Federal Health Insurance Portability and Accountability Act), as of April 14, 2003, this form must be signed by all patients prior to your office visit. For the more lengthy version (which goes into more specific details), please see the Notice of Privacy Practices form.
CONTACT LENS PRICE PROMISE - Please view this form for information regarding our contact lens pricing philosophy.
