Thank you for choosing Busby Eye Care!
Please take a few moments to gather some information before your visit to our office.
Forms to Complete In order to provide you with the best possible care, please complete, sign and date the following documents prior to your visit. The print version is available to print, complete, and bring to the office on the day of your appointment. Or to expedite your visit, the online version is available to complete online and will be submitted safely and securely to our office. Thank you for your time.
*For security reasons all of the following forms are encrypted in order to completely secure patient information sent to our office*
New Patients – Please Make Sure To Fill Out the Following Forms:
- Patient History Form – print version or online version
- Patient Lifestyle Questionnaire (Over 18) – print version or online version
- Patient Lifestyle Questionnaire (Under 18) – print version or online version
- HIPAA Privacy Notification and Acknowledgement Form – print version or online version
- Busby Eye Care Financial Policy – print version or online version
- Appointment Policy Acknowledgement Form – online version
- Records Release Form – print version or online version
- Infant SEE Questionnaire – print version
- Sports Vision Questionnaire – print version
Items to bring to your visit:
- Any glasses, sunglasses, contact lenses, and contact lens boxes
- Medical and/or vision insurance card
- Prior eye care records
- You can either bring these documents with you or have your previous doctor FAX them to our office at 317-896-5335
- Completed Patient History, Busby Eye Care Financial Policy and HIPAA forms