Registration Formscollassoc2018-10-26T18:00:38+00:00

Registration Forms

Please click on the links below to view and print our patient forms. Please bring these forms with you to your appointment.

Patient Forms

Registration Form

Medical History

Financial Policy

Notice of Privacy Practices Receipt

Notice Of Privacy Practices

Records Release Form

Surgery Center Forms

Surgery Center Medication Form

Surgery Center Anesthesia Guidelines

Surgery Center Patient Rights

Surgery Center Patient History Form

OUR MISSION

Our surgeons and staff are dedicated to providing unrivaled patient care and excellent laser eye surgery results.

"One pair of eyes...Yours. One name to trust...Ours." This exemplifies our commitment to providing you with the very best vision possible and to inspire your trust that your eyes are our first priority throughout every step of your care with Midwest EyeCenter.

OUR PROMISE

At MidWest EyeCenter, we are committed to your total eye care. Our staff provides an innovative and integrated approach, using state-of-the-art technology, combined with the utmost in personal attention and service. Whether it’s performing iLASIK or treating retina conditions or removing cataracts, you can be sure of the quality of vision care provided by our team of skilled, caring professionals.

Registration Forms

Please click on the links below to view and print our patient forms. Please bring these forms with you to your appointment.

Patient Forms

Surgery Center Forms

OUR MISSION

OUR VISION

OUR PROMISE

WEST CHESTER

FLORENCE

CLIFTON

DELHI

EASTGATE

CRESTVIEW HILLS

SPRINGDALE

KENWOOD

COLERAIN

THOMAS MORE PARKWAY