If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

We comply with HIPPA guidelines in order to ensure your privacy. Our observance of these guidelines is a requirement in order to maintain our accrediation with the Joint Commision for Accrediated Health Care Facilities (JCAHO); the same organization that accredits hospitals.

Patient Forms

Financial Policy SEC.doc

HIPAA Notice of Privacy Practices SEC.doc

NP Enrollment & Insurance Form SEC.doc

NP Medical History SEC.doc

Referring Doctors Forms

Referral Form.pdf

 

This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

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Specialty Eye Care Ophthalmologists, Abdulfatah M. Ali, M.D., E. Randy Craven, M.D., C. Starck Johnson M.D. and John Samples, M.D. - Locations in Denver and South Suburban area of Colorado.  Patient Forms information and downloads.