Patient Intake Form

Upon arrival for your appointment, all patients are requested to complete the Patient & Health History Form and the HIPPA Authorization Form. You are encouraged to download these forms, complete them, and bring them with you to your appointment.

  Appointment Checklist

  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 email it to Staff@EyeCarumba.com or fax it to the number indicated on the form. No cover sheet is necessary.