Patient Forms


To make your first visit quicker, please download the medical records release form. Download Medical Records Release Here

Refraction is one of the most important parts of your eye exam. Please download the form below agreeing to pay for this portion of the exam. Should your plan pay us for the refraction, you will be reimbursed accordingly.
Download Allied Eye Patient Forms Here

Patient Medical Records Requests

  • Most recent office visit is free of charge.
  • $25 fee for up to 1 year of medical records.
  • $50 fee for up to 3 years of medical records.
  • $15 fee for each additional year.

Our Cancellation and No Show Policy

For the convenience of all of our valued patients and staff, we ask for a 48 hours' notice whenever you need to cancel an appointment. Getting cancellation information in advance allows us to adjust our staff schedule or notify another patient who might be waiting for an appointment opening.

General Medical Records Request


  • $20 for the first 5 pages.
  • $0.50 for each additional page.

This fee should be charged to anyone requesting records other than a physician’s office such as an attorney, disability departments etc.

Worker’s Compensation

  • $10 for the first 20 pages.
  • $0.25 for each additional page.

Also, it is imperative that we make sure there is a waiver on file requesting those records. Nothing can be released, not even to the employer, without this form signed by the patient.