Online Patient Forms

At SightMD Pennsylvania, 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.

  • Download the required form(s). Print out the form(s) and complete the required information.

  • Fax your printed and completed form(s) to our office or bring them with you 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

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

Make an Appointment

Contact our team to book your appointment and find out what treatment plan is best for you.

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Related Locations

  • Allenwood
    Allenwood

    732-920-3737

    66 Enterprise Blvd
    Allenwood, PA 17810

  • Amityville
    Amityville

    631-608-1542

    805 Broadway
    Suite 106
    Amityville, NY 11701

  • Babylon
    Babylon

    631-957-3355

    500 West Main Street
    Suite 210
    Babylon, NY 11702

  • Barnegat
    Barnegat

    609-698-2020

    770 Lighthouse Drive
    #156-B
    Barnegat, NJ 08005