Get Detailed Appointment Information for Our Eye Clinic

Patient Forms

New Patient History Form

Patient HIPAA form

Consent to Bill Insurance company form

Appointment Agreement

Advance Beneficiary Notice of Noncoverage form (ABN)

Financial Agreement form

Medical Records Release form

To ensure a comfortable and successful office visit, here are a few things to consider ahead of time:

Arrival Time

Please arrive approximately 5 to 10 minutes prior to your appointment time so we can upload your information into our computer system.

Photo ID & Insurance Card

Have a photo ID and all insurance cards on hand. We recommend clarifying your health insurance benefits with a call to your carrier prior to your visit so that surprises are averted.

Medication & Allergy Information

Bring a medication and allergy list along, as well as a list of doctors who provide care for you. It is crucial that your medical records are current and accurate; to that effect, we will ask to update your information at every visit.

Medical Records

For continuity of care, have your medical records sent directly to our office prior to your appointment, or bring them with you to the visit. A Release of Medical Records form with Summit Eye Consultants information is provided below for your convenience.

Eye Dilation

Please note, your eyes will most likely be dilated, which will blur your up-close vision and sensitize you to light. It usually does not affect your ability to drive. However, should you not feel comfortable driving home with dilated eyes, please invite a driver along to your visit. A comprehensive eye exam can take anywhere from 45 minutes up to several hours depending on the complexity of your problems and whether treatment is combined with the exam. While dilating your eyes fully takes about 15-30 minutes, the effects of dilation can linger from two to four hours.

We thank you for choosing Summit Eye Consultants!

Summit Eye Consultants Appointment Agreement

Summit Eye Consultants strives for excellent patient care in an efficient and timely manner. As a courtesy to you and other patients, we request the following policies be acknowledged regarding appointments. These policies will allow us to better utilize appointments for patients requiring immediate medical attention.​

If you are more than 30 minutes late to your appointment and have not notified the office of your estimated time arrival due to unexpected events, your appointment will be rescheduled to the next available appointment.
Missed Appointments: If an appointment is missed, a fee of $45.00 for each missed appointment will be charged to the account. If more than 3 appointments are missed, the staff will not reschedule a fourth appointment and the patient will be notified by mail, and hereby dismissed.

If an appointment needs to be cancelled, we kindly request notification 24 hours prior to the appointment. This allows the staff to open the appointment slot for same day appointments. No fee will be applied to the first late cancel; however, after the second late cancel, a fee of $45.00 will be charged to the patient account. If after 3 late cancels, the opportunity to reschedule will not be available and hereby dismissed.

Should an appointment be rescheduled, we ask for a minimum of 24 hours notification. No fee will be applied to the first late rescheduled appointment; however there will be a $45.00 fee added to the patient account for each additional late rescheduled appointment. After 3 late rescheduled appointments occur, the option to reschedule will not be available and will be notified by mail regarding dismissal.
These policies have been set in place to bestow courtesy to all patients. By allowing the staff ample time to acknowledge that an appointment time may not suit your needs, the staff will be able to appropriately fill the slot for patients seeking urgent medical attention. We thank you for your cooperation and understanding.”