icon_pdf-2x  Patient Intake Form

Upon arrival for your appointment, all patients are requested to complete the Patient & Health History Form and the HIPAA Authorization Form. You are encouraged to download these forms, complete them, and bring them with you to your appointment. You may also upload your Patient Intake Form here. Be sure to save your answers before uploading!

icon_pdf-2x  Appointment Checklist

Download the appointment checklist above to ensure you are prepared for your visit.

icon_pdf-2x  Request for Release of Healthcare Information

To have your most recent examination records and prescription released to Eye Carumba Optometry, download the "Request for Release of Healthcare Information" form, complete the Release form, then upload it to the HIPAA compliant link provided below or fax it to the number indicated on the form. No cover sheet is necessary.

Cancellation Policy: Cancellations less than 24 business hours prior to your scheduled appointment will be charged a $50 cancellation fee. This is an out-of-pocket fee that will not be paid by your insurance. For questions, please direct your messages to:

Map     ↓ Phone Hours