patient forms

Your eye health and vision care are our primary concerns at Burrows Vision Clinic.  To assist us in serving you we ask patients to complete forms regarding your eye health and history.  In an effort to enhance your visit with us we have provided forms for you to review and complete at your leisure.  Print each of the forms that apply to you, fill them out and bring them with you at your appointment.  You will receive a free gift as a token of our appreciation.

Medical & Social History

Medicare Payment Authorization (Medicare patients only)

Medicare Secondary Payer Questionnaire (Medicare patients only)

HIPAA Notice of Privacy Practices