Save time on consultation day.
Most of our patient paperwork can be completed at home - saving 15-20 minutes at your consultation. Download the relevant forms below, fill them out, and bring them with you (or upload them to your patient portal).
- 20/Happy Patient Guarantee
- Dr. Shehzad Batliwala, Board-Certified
- Aftercare included
- FSA/HSA + 0% APR financing
Print at home or fill out on a tablet.
Forms are PDF fillable. You can complete them on a computer or print and write by hand. Bring them on consultation day or email them ahead to team@visionaryeyesurgery.com for our records.
If you'd rather complete forms in our office, that's perfectly fine - bring photo ID and your insurance card and we'll handle everything when you arrive.
The five forms we send most patients.
New patient intake
Demographics, medical history, current medications, and insurance information.
Open patient portalMedical records release
Authorize Visionary Eye to send or receive your medical records from another provider.
Open PDFNotice of Privacy Practices
Our HIPAA Notice of Privacy Practices, how we use and protect your health information.
Open PDFPre-LASIK questionnaire
Vision history, contact-lens use, prior eye conditions, and lifestyle questions specific to refractive surgery.
Open patient portalHIPAA authorization
Standard authorization to release your health information to designated parties.
Open patient portalFinancial responsibility
Estimate acknowledgment and payment authorization for your scheduled procedure.
Open patient portalSurgical consent
Detailed consent form specific to your scheduled procedure, provided after evaluation.
Open patient portal
Medical records release and Notice of Privacy Practices open as PDFs. Other forms are completed through the patient portal or provided by our office.
Your records are never shared without your consent.
All forms are stored in HIPAA-compliant systems. We don't sell or share patient data, ever. If you'd like the full details of how we handle protected health information, open our Notice of Privacy Practices.
See what better vision looks like. At any stage of life.
Glasses on the nightstand. Contacts fighting you at the gym. The menu blurring at dinner. You don't have to live with it. Come find out what's possible for your eyes.
- 7,000+
- Surgeries by Dr. Shehz
- 2×
- Board-certified
- 1
- Surgeon. Every case.
- 5★
- Patient-rated on Google
- 20/Happy Patient Guarantee
- Dr. Shehzad Batliwala, Board-Certified
- Aftercare included
- FSA/HSA + 0% APR financing