Online Forms

ROUSE EyeCARE CENTER offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReaderĀ® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Paperwork- Required Download & Print Form or Submit Online
This is our new patient paperwork. PleaseĀ fill this out and bring it with you to your appointment.
Also please print out the Payment & Financial Policy.

Payment & Financial Policy- Required Download & Print Form
This is our updated Financial Policy. It is for new patients and patient we have seen before July 2012. Please print out and fill out in blue ink if possible, and bring with you to your appointment.

Consent to Use or Disclose Medical InformationDownload & Print Form

Information Release Form Download & Print Form

Medical QuestionnaireDownload & Print Form

Routine Vision BenefitDownload & Print Form