What To Bring
What To Bring To Your Appointment
At Pollack Eye Care, we strive to make your visit with us as convenient as possible. We will help you understand your insurances, submit claims to your insurance company, and answer fully and honestly any concerns or questions you may have. We would like to assure you that you are important to us. We will give you the attention and devotion you deserve.
To simplify this process, we ask that you come prepared and bring the following items with you. All co-pays are due the day of your visit.
COMPLETED PATIENT FORMS (Below)
Insurance ID Card
LIST OF ALL MEDICATIONS
ANY INSURANCE REFERRALS
CURRENT EYEGLASSES
Patient Forms
For your convenience, we ask that you fill out any applicable forms prior to your initial visit. To expedite this process, we request you download, review, and complete these forms beforehand and bring them to your appointment.
These completed forms are crucial as they assist our providers in understanding your medical history. We depend on the accuracy and thoroughness of this information to offer you the highest standard of care.
PATIENT INFORMATION
Single Page Form
Download PDF
PATIENT CONSENT FORM
Single Page Form
Download PDF
MEDICAL HISTORY QUESTIONAIRE
Two Page Form
Download PDF
MEDICAL HISTORY – UPDATE
Single Page Form
Download PDF
INSURANCE POLICY HOLDER INFO
Single Page Form
Download PDF
FINANCIAL POLICY/ MEDICAL RELEASE
Single Page Form
Download PDF
CANCELLATION POLICY
Single Page Form
Download PDF
