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Patient Forms

New Patients

Welcome!

If this is your first time coming to our office, there will be some forms that must be filled out. Please save yourself some time by printing and completing the forms below and plan on bringing them to your first appointment.

Routine Waiver Form
Health History Form

Patient Demographics Form
HIPAA Privacy Policy
Optional Form


Existing Patients

If you are a patient who has been to our office before, the following forms are required once a year.

Please bring the following forms to your yearly appointment:

Health History Form
Patient Demographics Form


To Request Medical Records

Please complete the Medical Records Release Authorization Form and fax it to 203-778-6238 or mail it to:

Attn: Medical Records Department
Danbury Eye Physicians & Surgeons
69 Sand Pit Road
Danbury, CT 06810
 
Any questions, please call 203-791-2020 Ext. 268 or email medicalrecords@danburyeye.com


To schedule an appointment please call 203-791-2020.

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