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  • M
  • 9-7
  • Tu
  • 9-6
  • W
  • 9-6
  • Th
  • 9-6
  • F
  • 9-1

Forms

Click on any of the pdf icons below to open the corresponding forms:

pdf iconNotice of Privacy Practices – part of the Health Insurance Portability and Accountability Act (HIPAA), this notification explains your privacy rights as a patient

 


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Release of Medical Information –  used to transfer your medical records from another office

 


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Advance Beneficiary Notice of Noncoverage (Medicare Patients Only) – explains any fees that are not covered by Medicare.  The fees are based on the services being rendered to each patient. Every Medicare patient receives this form during check-in.

 

pdf iconAmsler Grid Test – a tool that Dr. Kara uses to help detect vision problems resulting from damage to the macula (the central part of the back of the eye) or the optic nerve