Eye Care of Delaware Forms

A. New Patient Forms (Eye Care of Delaware; Dr. Boyd or Dr. Mitchell)

  • Patient Health Questionnaire
  • Medication List
  • Privacy Authorization & Assignment of Benefits (HIPAA)
  • Directions

B. Cataract Evaluation with Dr. Boyd

  • Welcome Letter
  • Lens Options Information
  • Cataract Lifestyle Questionnaire
  • Medication List
  • Patient Health Questionnaire
  • Privacy Authorization & Assignment of Benefits

C. Cataract Surgery and Evaluation on the same day

  • Welcome Letter
  • Lens Options Information
  • History and Physical Form
  • Medication List
  • Patient Health Questionnaire
  • Privacy Authorization & Assignment of Benefits
  • Patient’s Bill of Rights

D. New Patient Forms for Screenings (Kamra, LASIK, PRK, ICL, Refractive Lens Exchange)

  • Patient Registration
  • Refractive Surgery Questionnaire
  • Privacy Authorization
  • Directions

E. Notice of Privacy Practices

F. Non-Discrimination Policy

Care Credit (more information)

  • Link to application for finance company.