Patient Forms
If you are a new patient, please complete the following forms prior to your first appointment. Refer to ‘Patient FAQs’ to review our Privacy Policies, Financial Policies, Treatment Consent, and Patient Portal Consent.
If you choose to complete the paperwork in office please arrive 20 minutes prior to your appointment time.
If you choose to upload the new patient paperwork to the patient portal, then please download the New Patient Paperwork Packet in PDF (via Adobe Acrobat), complete online or by hand, and upload to the MyDocuments portion of the portal.
The new patient packet includes the following forms to complete:
Please also note the updated Patient Protection and Affordable Care Act Section 1557 Notice:
In addition, if the patient is a minor then a parent or legal guardian will need to complete the following form in addition to those above.
If you have previously been seen by an ophthalmologist or optometrist please utilize the following medical records release form to have your medical records faxed to our office.
FAQ WHITE TEXT
FAQ
How do I make an appointment?
Please call us at 972-691-EYES (3937) to schedule an appointment.
You will be asked for insurance information and the reason for your visit. Once your appointment is scheduled you will be directed to the appropriate new patient paperwork.
What do I bring to an appointment?
Please Bring With You to Your Appointment:
Medications – Please either bring a current list of all medications you are taking, or the medications in the bottles as received from the pharmacy.
Eyeglasses and/or Contact Lenses – Please bring your best or most recent contact lens prescription or eyeglasses, even if they no longer improve your vision. This will provide important information about the past condition of your eyes.
Insurance Cards – Please bring all current insurance cards with you to the appointment. We will bill your medical insurance, primary and secondary, for the medical eye exam and any additional tests, studies or procedures performed. Any unpaid visits due to invalid insurance cards will become the patient’s (parent/guardian) responsibility.
Photo ID – We are required to obtain a copy of your photo ID. This is to protect you from someone else using your medical insurance (a type of identity theft).
Referral - If your insurance provider requires pre-approval or physician referral please bring these forms.
Medical Records - If you have been previously seen by an ophthalmologist please bring any medical records you may have.
Transportation - Should you expect to undergo a dilated eye exam (for example as a new patient or during a retinal evaluation) please bring sunglasses for your comfort and arrange for a driver or other transportation.
New Patient Paperwork - Prior to your appointment, please fax or email to our office your new patient paperwork. If you are unable to do so, please bring the completed forms with you to your visit. These forms will also be available at our office for you to fill out in person on the day of your appointment. If you choose to fill these out in person please arrive 20 min prior to your appointment time.
How long would my appointment take?
The length of your visit depends on the reason for your appointment.
Please plan to arrive 10 minutes before your scheduled visit. If you prefer to complete your new patient paperwork in office please arrive 20 minutes prior to your scheduled appointment time. Typically, plan to spend 2 hours at our practice for a dilated or new patient exam.
What can I expect during my cataract evaluation?
A cataract evaluation takes place in the office with your prospective surgeon. At this appointment, you should prepare to have your eyes dilated. Your surgeon will throughly examine your eyes and discuss your needs and limitations. If you qualify for surgery, your surgeon will create a surgical plan tailored to your needs and discuss your surgical options.
Please review the below videos for further information:
What COVID precautions are in place?
At Eye Associates of Texas, we prioritize the safety of our patients, staff, and visitors. We follow CDC (Centers for Disease Control and Prevention) and TMA (Texas Medical Association) guidelines to ensure your safety and comfort. You can expect the following precautions in place at your next visit:
- Please bring a mask that covers both your mouth and nose.
- Please call our office (972-691-3937) once you are in the parking lot so that we may review any necessary information or paperwork.
- Patients will be asked to wait in their vehicle until their appointment time. At your designated appointment time you will be escorted from your vehicle into the building by a staff member.
- You will be requested to limit the number of visitors accompanying you, unless extenuating circumstances require a companion.
- Your temperature will be checked via a non-contact thermometer and you will be asked a series of screening questions.
- We ask that if you do have symptoms (fever, cough, shortness of breath) please call our office to reschedule and seek appropriate care.
Additional policies that we have put into place to ensure the health of all patients:
- Our schedule has been reduced to prevent crowding in clinic.
- Physicians and staff will wear appropriate PPE.
- Exam rooms and diagnostic equipment are disinfected after every patient in accordance with CDC guidelines to reduce risk of transmission.
Policies and Acknowledgments
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How do I access the Patient Portal?
Please call our office to receive your unique registration code. This code can be sent to you via email or text. Navigate to myPatientVisit.com and refer to the following instructions to access the patient portal.
Can I update my information via the Patient Portal?
Yes you can update certain information via the patient portal. With access to the patient portal you will be able to provide updated demographic information and upload pictures of your driver license and insurance cards.
In order to do so, go to myPatientVisit.com and access the Patient Portal. Navigate to the "myChart" tab. Under the "myChart" tab you can update your insurance information and your demographic information. You will be able to upload photos of your drivers license and insurance cards in this section as well.
Can I submit my new patient paperwork via the Patient Portal?
Yes, this is the preferred method of submission.
You will need Adobe Acrobat to view and complete these forms. You can download a free version using this link.
First download the Full New Patient Paperwork Packet form from our website and save to your desktop. Using Adobe Acrobat complete these forms.
Then go to myPatientVisit.com to access the Patient Portal. Navigate to the "myChart" tab and select "Upload Document". You will be able to upload the paperwork in PDF format.
While under the "myChart" tab you will be able to upload photos of your drivers license and insurance cards in this section. If you choose you can now confirm or update your insurance information and your demographic information.
If you are unable to electronically sign, you will be asked to sign a copy of the Acknowledgement and Consent form at the time of your appointment to ensure understanding of our financial and privacy policies. Refer to ‘Patient FAQs’ to review our Privacy Policies, Financial Policies, Treatment Consent, and Patient Portal Consent.
Insurance and Payment
What payment methods are accepted?
We accept several types of medical insurance, cash, and most credit cards.
What insurances are accepted?
We do accept several types of medical and vision insurance. Please call us at 972-691-EYES (3937) to find out more about your particular insurance coverage.
Section 1557 Notice
Discrimination is against the law. Eye Associates of Texas complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Eye Associates of Texas does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Eye Associates of Texas:
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
○ Qualified sign language interpreters
○ Written information in other formats
Provides free language services to people whose primary language is not English, such as:
○ Qualified interpreters
○ Information written in other languages
If you need these services, contact our office at 972-691-3937
If you believe that Eye Associates of Texas has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
Office Administration
4900 Long Prairie Rd Ste 400 Flower Mound, TX 75028
P: 972-691-3937 F: 972-691-3939
You can file a grievance in person or by mail or, fax.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
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