- Patient Demographics ( .pdf )
- Patient Medical History ( .pdf ) revised 07/2020
- Patients Rights (.pdf)
Pediatric Ophthalmology New Patient Information
Please select the first file if you wish to fill in the blanks using your computer. Only the gray areas accept typing. Please print and sign the completed form and bring it with you to your child’s appointment.
Please select the second file if you wish to fill in the form by hand. Leave “First Exam” and “Med Rec” blank.
HIPPA PRIVACY NOTICES & FORMS (all pdf files)
- Hippa Privacy Notice updated 9/23/13
- Request for Access to Medical Information
- Record Release Authorization FROM Cabarrus Eye
- Record Release Authorization TO Cabarrus Eye
Effective September 1, 2020 if you have confirmed through our appointment reminder system that you will keep your appointment and then you fail to show up or you do not give 24 hour notice, you may be charged a $50 fee. It is especially important during this time of social distancing due to Covid-19 concerns, and given that we have less available appointments for all of our patients, that you keep your appointment or give us a minimum of 24 hour notice of cancellation. We value our patients and appreciate your understanding of this policy.