ABQ Eye Care Forms

Click on the link below to fill out your patient history form:

 

Patient History

 

 

If you will be getting contact lenses at your appointment, please fill out this contact lens policy form:

 

Contact Lens Policy

 

 

If you would like to authorize someone for you to have access to your records or have someone pick up contact lenses/glasses for you, fill out the form here:

 

Authorization to Release Information

 

If you would like to send your records to another provider or another provider to send their records to us, fill out the release form here:

 

General medical release form

 

 

 

If you cannot click on any of the links, you can download and print the patient history forms here.  The HIPAA Policies are for your knowledge.  Thank you!

 

Patient Info Form - Pg 1
ABQ Eye Care Pt History Front.pdf
Adobe Acrobat document [240.6 KB]
Patient Info Form - Pg 2
ABQ Eye Care Patient History Frm Bk.pdf
Adobe Acrobat document [146.7 KB]
ABQ Eye Care HIPAA Policies
ABQ Eye Care HIPAA notice.pdf
Adobe Acrobat document [106.6 KB]

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5341 Wyoming Blvd NE, Suite A, Albuq NM 87109 call or text: (505) 717-2005 fax: (505) 312-7551 email: info@abqeyecare.com