Patient Forms

We know filling out medical forms is tedious and time consuming.  Now do it in your pajamas at home, where you have all your documentation.  Give us all the info we need on your own time and we will be ready for you when you arrive for your visit.
 

Once you make an appointment with us, you will receive a confirmation email with a secure password so you can create your login and fill out your forms here, before your visit with us. 

If you do not have a security code, please call us at (212) 220-0066.

"Never leave that till tomorrow which you can do today"

-Benjamin Franklin

Please be sure to save and finalize each page of these secure online forms; this way your information will already be entered into our system when you arrive for your appointment.

Are you new to our practice? Then New Patient Form is for you.

Are you one of our existing patients? Then Existing Patient Form is for you.

If you have health care insurance, any required co-payments and deductibles will be collected from you as required by your plan. Payment is collected at the time of your visit for any co-payments, deductibles or services not covered by your health care plan. If your plan requires you to obtain a referral for every visit to a specialist, and you do not provide us with this form, we cannot bill your insurance company, and therefore you will be responsible for payment. Payments can be made by cash, MasterCard, Visa, Discover or American Express.

Contact Us

 
New York, NY Ophthalmologist
Chelsea Eye Ophthalmology, PLLC
157 W 19th St.
New York, NY10011

(212) 220-0066
(212) 727-3789 Fax

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