Patient Forms | Coastal Eye Associates

(281) 488-7213

Patient Forms

Coastal Eye Associates understands that our patients want to have their office visit be as smooth as possible. To help facilitate this process, we have provided our patient forms online. You may print and complete the following forms, then bring them to your appointment. This saves you the effort of filling out the form after you get to the office.

Note: You will need Adobe Acrobat Reader to view these forms. Click here to download a free version of Acrobat Reader

	New Patient Information and Acknowledgment Form
	HIPAA – Notice of Privacy Practices
	Medical History Form
	Pediatric General History Form

Things to Remember for your Appointment:
•	Parents must accompany children under the age of 18 in order to complete and sign the necessary paperwork.
•	Arrive 10-15 minutes early to allow time for the check-in process.
•	Bring the following items with you:
	•	Photo Identification
	•	Insurance Card (medical and vision, if applicable)
	•	Any relevant medical records for existing conditions related to eye care
	•	Doctor Referral Form –(If applicable)
	•	Contact Lens wearers: please bring your most recent prescription and / or contact lens box

Please note: Though we try to adhere to your scheduled appointment time, emergency "work-ins" or unforeseen problems may occur and cause your doctor to run behind schedule. If the front desk is aware of any such circumstances, you will be notified at the appropriate time.

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