Patient Forms

Call (480) 706-3937 or email service@arizonasvision.com and tell us which appointment you have booked. We will send you the right packet.

Complete it before you arrive and bring it with you, or arrive about ten minutes early and complete it in the office. Either works, and doing it in advance simply means less time at the desk.

A few fields are worth more care than the rest, because they change what we look for during the exam.

List every medication, including over-the-counter products, supplements and eye drops. A great many common medications affect the eyes: antihistamines, diuretics, antidepressants and blood pressure medications all contribute to dry eye, some prostate medications affect the iris in ways a cataract surgeon must know about in advance, and hydroxychloroquine requires specific retinal monitoring. None of this means stopping anything you need. It means monitoring appropriately.

Be specific about family history. Glaucoma and macular degeneration both carry substantially elevated risk with an affected first-degree relative, and knowing that changes how closely we watch and what we test.

And describe symptoms in your own words rather than trying to sound clinical. My eyes water constantly and it is worse in the car is far more useful to us than epiphora, because the detail about the car points straight at an air vent aimed at your face. The specifics are the diagnostic information. When something started, what makes it better or worse, what time of day it is worst, and what you have already tried are all worth a sentence each.

Give us both your medical insurance and your vision plan, since they are frequently different companies and both may be relevant to the same visit.

A vision plan covers routine examination and an allowance toward glasses or contact lenses. Medical insurance covers the diagnosis and treatment of disease. If you come in for a routine exam and we find something medical, follow-up care for it bills to medical insurance. That is how the coverage is structured rather than a choice we make, and having both on file means we can apply the right one without chasing you for details afterward.

If you are unsure what you have, bring the cards and we will work it out. This is genuinely routine for us and it takes a few minutes, so it is not worth delaying an appointment over.

If you have been seen elsewhere, it is worth getting your records transferred rather than starting from zero, and the records release packet is how you authorise it.

What matters most is not the last prescription but the history. Previous corneal topography, retinal images, visual field results and intraocular pressure readings are all measurements whose value comes from comparison. A single pressure reading tells us relatively little. Five years of readings tells us whether something is changing.

This matters most if you have any condition being monitored: glaucoma or glaucoma suspicion, macular degeneration, diabetes, keratoconus, or a lesion under observation. In all of those, the previous data materially changes what we can say at your first visit with us.

Complete the release, tell us where you were seen, and we handle the request. It usually takes a couple of weeks, so it is worth doing before your appointment rather than after.

Information on these forms is protected health information and is handled under HIPAA. Our Notice of Privacy Practices sets out how it may be used and disclosed and what your rights are.

Please do not email completed forms containing health information. Email is not a secure channel. Bring the form with you, or complete it in the office.