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Your Appointment
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Advanced Eye Care of Miami
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Your Information
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Insurance Card
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Front of Card
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Health History
Quick questions to prepare your doctor
Describe your main concern
Do you have any of these eye conditions?
Any general health conditions?
Vision Correction
Family Eye History
Consent & Signature
Review and sign — takes under a minute
HIPAA Notice of Privacy Practices *
I acknowledge receipt of the Notice of Privacy Practices. I understand my health information may be used for treatment, payment, and healthcare operations.
Consent to Treatment *
I authorize the physicians and staff to provide examination, treatment, and procedures deemed necessary for my eye care.
Financial Responsibility *
I understand I am responsible for any balance not covered by my insurance, including co-pays, deductibles, and non-covered services.
Telehealth Services (Optional)
I consent to receiving care via telehealth platforms when appropriate, and understand the risks and limitations involved.
Eye Care Tips & Reminders (Optional)
Receive helpful eye care tips and appointment reminders via SMS/email. You can opt out anytime.
Your Signature *
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You're All Set!
Your intake is complete. Our team has everything they need for your visit.
Verified Patient
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Appointment
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Insurance on File
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Consents
Signed & Submitted
What to bring
A valid photo ID
Your current glasses or contact lens prescription (if available)
Arrive 5 minutes early — your paperwork is already done!