HOME Special Offer Meet the Doctors Insurance Accepted DONATE SIGHT-ITS FREE

PLEASE REGISTER YOUR HEALTH INFORMATION BY CLICKING BELOW

(Note: the password is typically a unique ID such as your social with dashes)

ONLINE REGISTRATION

Completing this before your examination will save you wait time before seeing the doctor.

ONCE YOU HAVE COMPLETED THE ABOVE REGISTRATION, YOU ARE DONE!  WE LOOK FORWARD TO SEEING YOU AT YOUR EXAMINATION!



AFTER COMPLETING YOUR EXAMINATION YOU NOW HAVE THE OPTION TO YOU TO VIEW YOUR OWN RECORD!

VIEW YOUR PERSONAL HEALTH RECORD

Click here to view your completed online record after completing your examination. 


**ONLY IF YOU COULDN'T COMPLETE THE ABOVE REGISTRATION**

If you are unable to complete the online registration above, you may print out the forms below and bring them with to you examination.  Keep in mind this will add some wait time and the Online Registration above is preferred.

PLEASE CLICK BELOW ON BOTH FORMS THEN PRINT OUT AND COMPLETE THEM BEFORE YOUR APPOINTMENT.

PATIENT HISTORY FORM

HIPAA SIGNATURE / INSURANCE FORM

THANK YOU!

WHEN COMPLETED, YOU MAY FAX  TO 870-336-2455

OR

 BRING THEM TO YOUR APPOINTMENT

WE LOOK FORWARD TO MEETING YOU SOON!


PLEASE REVIEW OUR UPDATED NOTICE OF PRIVACY PRACTICES (EFFECTIVE 9/23/13) BY CLICKING BELOW

NOTICE OF PRIVACY PRACTICES

HOME Special Offer Meet the Doctors Insurance Accepted DONATE SIGHT-ITS FREE


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