Information About Your Visit
We are committed to help everyone in need of our services. Our staff is available to assist you with any questions or concerns.
We ask those who are visiting us for the first time, to please arrive 10 minutes early for registration and to fill out a health questionnaire. These forms are also available on our website. Once the forms are completed, you can either e-mail them to our office or bring them to your appointment date.
Please fill out and print the following forms. They will be needed at your first visit:Download All Here
- Payment: What You Need to Know
- Authorization to Release Medical Records
- Patient Information Sheet
- New MDI Paperwork
- Acknowledgement of Receipt of Privacy Notice
- Family Health History
- Medical History
- Patient Access to Medical Records
- New Patient Information Demographics
- Patient Review of Systems
- Acknowledgement of Receipt of Privacy Notice en Español
- Family Health History en Español
- Medical History en Español
- New Patient Information Demographics en Español
- Notice of Privacy Practice en Español
- Patient Review of Systems en Español
Note: Insurance cards and Identification must have matching names or other identifying documentation will be needed upon visitation.
Notice of Electronic Disclosure of Protected Health Information
If Ophthalmology specialists of Texas, PLLC (OST), obtains or creates information about your health, Ophthalmology Specialists of Texas, PLLC, is required by law to protect the privacy of your information. Protected health information (PHI) includes any information that relates to:
- Your past, present, or future physical or mental health or condition;
- Health care provided to you; and,
- Past, present, or future payment for your health care.
OST may not disclose your PHI electronically without your authorization unless allowed by law. For example, OST share your PHI through approved, secure electronic methods for the purpose of treatment, payment for health care services, or health care operations such as case management or care coordination. OST also need to share your PHI electronically for public health purposes such as preventing and controlling the spread of infectious diseases or for certain disaster relief efforts. For a complete list of reasons that OST allowed by law to share your PHI, please refer to the OST Privacy Notice
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