PATIENT FORMS

PATIENT FORMS

We look forward to meeting you at Cokingtin Eye Center. For your convenience, please print the appropriate new patient forms and complete them before your first visit. Please bring the forms with you to your first appointment, along with the list of medications you currently take, a valid form of identification and your insurance card.

New patients, please click here to view and print your Cokingtin Eye Center forms.

New CATARACT patients, click here view and print the necessary forms.

To download our financial policy, please click here.

To download our privacy policy, please click here.

Cokingtin Eye Center/Midwest Eye Consultants does not discriminate against any person on the basis of race, color, national origin, disability, or age (and any other bases you wish to include) in admission, treatment, or participation in its programs, services and activities, or in employment, or on the basis of sex in its health programs and activities.

For further information about this policy, contact: Christine Balestrieri, Section 504 Coordinator, 913-491-3737.