Blanco Kays Corgiat Eyecare
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Blanco Kays Corgiat Eyecare
  • Home
  • Forms
  • About
  • Order Contacts

PATIENT FORMS

Please print, complete forms, and bring with you to your scheduled appointment along with the patient (or guardian) photo ID, 

medical/vision insurance cards, and list of medications including over the counter supplements/vitamins.

Patient Information Form (pdf)Download
HIPAA Acknowledgement (Notice available upon request) (pdf)Download
Medical/Ocular History (pdf)Download
Medication log (complimentary) (pdf)Download

MEDICAL RECORDS

Records Release Form (pdf)Download

Policies for review

Notice of HIPAA Privacy Practices (pdf)Download
Blanco Kays Corgiat Eyecare - SMS Privacy Policy (pdf)Download

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