Sugar Land Total Eye Care
Please print out and complete all pages and bring in with you to save you time.
You will also be asked to complete all pages in the new patient insurance authorization in order to file with your insurance. This is required by the insurance company. This is the other new patient form selection. Please fill out both selections.
If you prefer, you can email this to Paula. Paula.SLTECare@gmail.com. We also will accept a faxed report, 281-265-1286. You may be asked to sign the signature page when you arrive. Thank you.
Please print out and complete all pages and bring to the office to save time.
You will be asked to fill out the new patient medical history which is the other selection of forms. So, please complete both selections and bring with you.
You may also email the forms to Paula: Paula.SLTECare@gmail.com. You may also choose to fax the forms to 281-265-1286. You might be asked to sign the signature page. Thank you.
|This PDF requires a free plugin that may have come included with your browser. If you are having difficulties opening this file Click Here to go to Adobe's web site for Acrobat Reader.|