It is always our goal at Somers Eye Center to give you the eye care you deserve in a timely manner.
In order to ensure that your first visit goes smoothly, you may want to complete the forms below prior to your visit. You can even fax us your forms or drop them off prior to your appointment to speed up your first visit.
New Patient
Demographics
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HIPAA Compliance
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Financial Policy
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Consent Form
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Returning Patients
HIPAA Compliance
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Patient Financial Policy
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Consent Form
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Records Release Request
Please complete the form below and fax (816-221-3713) to our billing department to begin the process to transfer your medical records.
Records Release Form
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Notice of Privacy Practices
We value patient privacy and do all we can to protect your information. Please review our Notice of Privacy Practices to be informed about how we may use or disclose your protected health information.
Notice of Privacy Form
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Download (Spanish)
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If you have any questions about our office or our forms, do not hesitate to contact us today at 816-842-2015.