Below are the forms with Dr. Arnold D. Craft. Feel free to print these forms out and bring them with you to your visit completed. You can also e-mail them to [email protected].
- Notice of privacy practices
The HIPAA Privacy Rule requires health plans and covered health care providers to develop and distribute a notice
- Authorization for use/disclosure of health information
An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.
- Medical history questionnaire
Health history questionnaire (online) Have your patients fill out this questionnaire template online prior to their first appointment. The form has sections for personal health history, health habits and personal safety, family health history, mental health, women only, men only, and other problems.
DO YOU HAVE A QUESTION? FEEL FREE TO CONTACT us
We offer emergency services that require immediate and urgent eye care. If your eye is injured, don’t try to judge the severity of it. Immediately seek the opinion of an eye doctor to lessen the risk of hurting your vision. We understand ocular emergencies can arise at any time.
We take pride in building lasting relationships with our patients, which is why we take the time to get to know you, your vision requirements and your lifestyle needs. Contact our eye care clinic today to find out how we can help.