Patient Forms

Lake Eye Associates policy requires a parent or legal guardian to accompany all minors under 16 years of age when visiting our team or undergoing treatment.

Patients between 16 and 18 may come in for follow-up appointments on their own. However, we still require a parent’s or guardian’s permission by filling out the Permission to Treat a Minor form below.

Patients over 18 are considered adults under HIPAA laws. Parents and legal guardians may not have access to another patient’s health history without the patient’s explicit consent, regardless of who is paying for their treatment or providing insurance.

Please fill out this form:

• Permission to Treat a Minor

Our office is dedicated to maintaining the privacy of your Protected Health Information (PHI). This includes such data as your name, address, phone number, date of birth, Social Security number, account information, medical record number, or any other unique identifying number.

In conducting our business, we will maintain records regarding you and the treatment and services provided to you. We are required by law to maintain the confidentiality of health information that identifies you.

Please fill this form to authorize the release of your medical records to our practice.