910.295.2100
Forms & Downloads
For your convenience, we have made a number of forms available to view or download. These forms are in the free Adobe Reader PDF format and can be opened by clicking on the form name. If you do not have Adobe Reader® on your computer, you can download it for free by clicking here.
Patient Forms
- Consent for Evaluation/Examination of Minor Child (C0510)
- New Patient History Form (C0620)
- New Patient Registration Form (C0043)
- New Patient Information Guidelines
- Notice of Privacy Practices
- Patient’s Request to Access Protected Health Information (C0496)
- Refractive Cataract Surgery Patient Questionnaire (C1021)
Referring Doctor Forms
- Comanaging Doctor Postoperative Cataract Surgery Report (C0319)
- Comanaging Doctor Postoperative Crystalens Report (C0920)
- Comanaging Doctor Postoperative Premium Lens Report (C0968)
- Comanaging Doctor Postoperative Refractive Surgery Report (C0368)
- Comanaging Doctor Postoperative YAG Laser Report (C0578)
- Comanaging Doctor Refractive Admittance Report (C0251)
- Request for Consultation (C0893)
- Refractive Cataract Surgery Patient Questionnaire
- iStent-Cataract and mild-moderate angle glaucoma(C1041)
Employment Forms
- Application for Employment (C0298) (This form must be printed out and completed. It can then be faxed or mailed. Fax # 910-295-3625. Address: Carolina Eye Associates, Attention: Human Resources, 2170 Midland Road, Southern Pines, NC 28387