Patient Forms

To help make your visit as smooth as possible, we’ve put all the necessary patient forms online and in one convenient place! Filling them out before your appointment means less time in the waiting room and more time focused on you.

If you’re a new patient or just updating your records, we’re making the experience as easy and stress-free as possible. Click below to view and/or complete the required patient forms. If you have any questions or need assistance, we’re just a phone call away. Your journey to clearer vision starts at The Eye Clinic.

HIPAA Release Form
View / Download

Insurance Assignment
View / Download

Medical Records Release
View / Download

Privacy Policies
View / Download

Non-Covered Services
View / Download

Activities of Daily Living
View / Download

If you don’t see your insurance plan and have questions about coverage, please call our insurance department at (337) 478-3810

Aesthetic Center

Aesthetic Center

Where Beauty & Confidence See Eye-to-Eye

Surgical, Skincare, Injectables and more

LASIK

LASIK

Life In Focus Without Frames

Long-Lasting, Precise Vision Correction

Retina
Center

Retina Center

Focused on the Health Inside Your Eyes

Specialized Care, Advanced Diagnostics, & In-Office Treatments

Cornea

Cornea

Healing Your Window to the World

Advanced Solutions for Complex Eye Conditions

Contact Us

Lake Charles
DeRidder
Jennings
Moss Bluff
Sulphur

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Contact Us

Lake Charles      DeRidder
Jennings             Moss Bluff
Sulphur

* Required fields

"*" indicates required fields