EXPERIENCE THE CORNEA CONSULTANTS DIFFERENCE

EXPERIENCE THE CORNEA CONSULTANTS DIFFERENCE

PATIENT FORMS

Patient Registration Form

Thank you for choosing Cornea Consultants of Albany for your eye care; we look forward to seeing you at your upcoming appointment. Please take a moment to complete and print the Patient Registration and Medical History Forms included in the Patient Registration Packet, even if you are an established patient. On the day of your appointment, please bring the completed forms with you; this helps make your time at our practice as efficient as possible. Also remember to obtain a referral from your primary care provider, if required by your insurance plan, prior to your appointment. Please bring your medical insurance card(s) with you as well as a photo ID.

We highly recommend that you read our Office Policies included in the Registration Packet so you can contact us if you have any questions. We look forward to seeing you!

Medical Records Release

Please fill out the form above to facilitate the release of your medical records. The form is pre-populated to allow the transfer of your records from another facility to Cornea Consultants of Albany with as little effort on your part as possible. If you would like your medical records to be transferred from our practice to another facility please copy the Cornea Consultants of Albany information in the “TO” field and paste it into the “FROM” field. Then simply enter the information of the facility that you want your records transferred to in the “TO” field.

After filling out the form please print and sign it, then mail it to:

Cornea Consultants of Albany

  • Attn: Medical Records 9 Vista Boulevard Slingerlands, NY 12159

Or you can fax it to:

  • (518) 475-0645

For your convenience, this information is already included in the form.

Software Requirements Adobe ReaderVersion 7.0 or later is required for viewing and printing the Portable Document Format (PDF) documents. To download the latest version of Adobe Reader, please click on the following link.

ALBANY MEDICAL CENTER
DEPARTMENT OF OPHTHALMOLOGY - DIVISION OF CORNEA, CATARACT AND REFRACTIVE SURGERY.

Ready to request an appointment?

Fill out the form and we will get back to you shortly!

We value your privacy.
 

CLICK ON THE MAP FOR DIRECTIONS TO THE CENTER FOR EYE CARE EXCELLENCE 

Center for Eye Care Excellence