Patient Forms

Direct Eye Care

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

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

Patient COVID-19 Protocol

Information on what you can do when arriving at EyeCare for You to protect yourself during COVID-19

Release of Medical Information

Form used to transfer your medical records from another office to EyeCare for You.

Amsler Grid Test

A tool that Dr. Ramsey 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.

Schedule an appointment today by calling 919.249.2020 or book online with the button below.