standard-title New Patients

New Patients

Welcome to Pediatric Eye Consultants of North Florida!

Thank you, we appreciate your time and look forward to meeting you. To expedite your registration process, our New Patient Forms are available online. We request that you take a few minutes to open and complete each form, then either send it to us via email or print and fax prior to your first appointment.

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Free Download: Adobe Reader

All browsers do not support filling form fields online. Download a forever free copy of Adobe Reader here! Download Adobe Reader

Complete Forms Online

Once opened in your browser, you may use your keyboard and mouse to completely fill out each form. Save a copy of the completed form and either email it to info@kidseyesjax.com or print and fax them to (904) 425-9414. If you are faxing the forms to us, please be sure to sign each Signature field manually. If sending by email, we will request your signature at time of registration. If you have any questions, please call us at (904) 425-5075.

New Patient Forms:

Patient Registration Form
Financial Policy
Vision Versus Medical Insurance
Accepted Insurance
What is CareCredit™
Health Information Release
Privacy Policy

 

Patching Pirate App for iPhone and iPad

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