Patient Forms

If you are new to Element Eye Care, please fill out the Patient Information Form and Offered Services before coming in for your exam.  This will help save you time the day of your exam and allow for better preparation before your exam.  If you are a contact lens wearer please carefully read and sign our Contact Lens Policy as well. Thank you and we look forward to meeting you soon!!

 

PATIENT INFORMATION FORM & OFFERED SERVICES

 

CONTACT LENS POLICY

 

Please fill out the Medical Record Release Form, if you are planning on transferring your care to Element Eye Care or you would like your medical records from your previous eye exam/s sent to us.

 

MEDICAL RECORD RELEASE FORM

 

 

If you are ever questioning what your rights are as a patient and/or want to know how we use the information you provide to us read the documents below:  

 

AUTHORIZATION OF HIPPA POLICY

 

 

NOTICE OF PRIVACY PRACTICES

 

Please let us know how we are doing, we always love to hear your ideas and feedback, so we can continue to grow and provide you with the best care and service possible.

 

PATIENT SATISFACTION SURVEY

ELEMENT EYE CARE

 

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Concord Mills

Ph:   (704)-996-3277

Fax:  (704)-979-6236

 

Matthews

Ph:   (704)-992-9410

Fax:  (704)-846-6352

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