Printable Forms

These forms can be downloaded on your computer, then printed, filled out and brought in to our office for our convenience and yours. If you can’t view the forms, please download Adobe Reader and then try again.  For appointment-specific intake forms and other interactive features please visit the secure patient portal.

Patient Registration Form
This intake form is for any patient who has never seen a practitioner at Visions HealthCare. To save time, please print the form, fill it out out, and bring it completed to your first appointment. Please do not mail or fax this form. Copies will also be available in person at Visions, and can be filled out when you arrive.
HIPAA Release Waiver
In the interest of protecting patient privacy, patient information will be discussed only with the patient him or herself, or with those specifically authorized by the patient to have access to such information (this includes, but is not limited to, appointment information and medical history). Please complete this form if you would like to authorize access to your patient information for anyone other than yourself. Once completed, this form can be mailed, faxed, or brought to Visions in person.
Authorization to Release Medical Records
This form authorizes Visions HealthCare to release your medical records to those individuals and/or institutions you specify. Should another doctor, office, or practitioner require these records, Visions must have this completed form on record before any patient information can be sent. Once completed, this form can be mailed, faxed, or brought to Visions in person.
Authorization to Obtain Medical Records
This form authorizes Visions HealthCare to obtain your medical records from those individuals and/or institutions you specify. Should a Visions practitioner require your medical records, our office must have this completed form on record in order to request your records from another doctor, office, or practitioner. Once completed, this form can be mailed, faxed, or brought to Visions in person.
Allergy Testing Medications to Avoid
In order to determine your body’s natural response to allergens, we ask that you avoid certain medications just prior to your scheduled allergy test. Please review this form prior to your scheduled allergy test.