Patient Forms

LUX PATIENT EXAM FORM

Eye Exam

If you have an upcoming exam at LUX and want to do your paperwork ahead of time... CLICK HERE.  

New patients fill out both pages.  Established patients only fill out 2nd page and update any information that may have changed since we saw you last on the first page.

Privacy Policy

Photographer

Your rights in terms of your personal information and how your information is used by our office.  Privacy of your information is pertinent to us, you can further read steps taken at LUX to fully comply with HIPPA regulations.  CLICK HERE

INSURANCE AUTHORIZATION

Insurance Agent

Form discussing insurance payment and patient liability for any charges not covered by your insurance plan for any reason.  

 

CLICK HERE

MEDICAL RECORD RELEASE

Doctor with Files

Fill out this form if you would like to have your medical records transferred from your previous eye care provider to LUX Eye Care.  

 

CLICK HERE