Online Patient Forms
At SightMD New Jersey, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.
New Patient Information Form – Required
Please complete this form as it lets us know your basic personal and insurance information as well as who to contact in the event of an emergency.
Download & Print Form
Medical History Form
Please complete this form as it lets us know your basic Medical History information as well as any existing eye problems, previous surgeries, medications you are taking or allergies you may have.
Download & Print Form
Permission To Accompany A Minor
By law, any child under the age of 18 years old cannot be seen by a doctor without written consent from a parent or without an adult present. If the minor is under 16, he/she must be accompanied by an adult. If the minor arrives with someone other than a parent or legal guardian, we must have written permission from the parent or legal guardian that this person has been appointed by you to act on your behalf.
Download & Print Form
Records Release Authorization
The medical record information release (HIPAA) form lets a patient allow any person or 3rd party to have access to their health records.
Download & Print Form
HIPPA Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Download & Print Form
Financial Policy
At SightMD, we are dedicated to providing the best possible care and service to you. We regard your complete understanding of your financial responsibilities as an essential element of your care and treatment. In order to reduce confusion and misunderstanding between our patients and the practice, we have adopted the following financial policy. Unless other arrangements have been made in advance by either yourself or your insurance plan, full payment is due at the time of service.
Download & Print Form
