For your convenience, we have made a number of forms available to view or download. These forms are in the free Adobe Reader PDF format and can be opened by clicking on the form name. If you do not have Adobe Reader® on your computer, you can download it for free by clicking here.
Patient Forms
- Consent for Evaluation Examination of Minor Child
- New Patient Medical History Form
- Notice of Privacy Practices
- Medical Records Request to Access Patient’s Protected Health Information
- AAO Initiative in Vision Rehabilitation
- Southern Pines/Pinehurst Map
- Carson C. Cox III Memorial Music Scholarship
Referring Doctor Forms
- Comanaging Doctor Postoperative Cataract Surgery Report
- Comanaging Doctor Postoperative Premium Lens Report
- Comanaging Doctor Postoperative Refractive Surgery Report
- Comanaging Doctor Postoperative YAG Laser Report
- Comanaging Doctor Refractive Admittance Report
- Request for Consultation
- Glaucoma Referral Request
- iStent Cataract and Mild-moderate Angle Glaucoma
Notice of Non-Discrimination
Carolina Eye Associates, P.A. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
View Carolina Eye’s Notice of Nondiscrimination and taglines that alert individuals with limited English proficiency (LEP) to the availability of language assistance services.
