Forms

 

Patient History Form

Notice of Privacy Practices

For our new patients – in order to save time and be more efficient at your appointment, please:

1)  Click the links above (require Adobe Reader to open).

2)  Print out our Patient History Form and sign our Notice of Privacy Practices.

3)  Fill out the forms to the best of your knowledge.

4)  Bring them with you to your eye exam appointment.

 

HIPAA Patient Release Form

For our existing patients requesting release of their medical record information to a third party, please:

1)  Click the link above (requires Adobe Reader to open).

2)  Print out our Patient Release Form.

3)  Fill out the form to the best of your knowledge.

4)  Send the completed form back to our office using one of the following methods:

  • Fax  –  410. 752. 8208
  • Email  –  krishan@federalhilleyecare.com
  • Mail  –  1029 Light Street Baltimore, MD 21230