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887 Old Country Road Suite K-L Riverhead, NY 11901
631-727-2858
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At Sound Vision Care, Inc., we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

soundvisioncare-history-form-20140501

Patient History Form - English

To be completed by all new patients and any patient that has not had an appointment in a year or this calendar year.

Patient History Form - English ( click to view )

 


soundvisioncare-spanish-history-form-20140208

Patient History Form - Spanish

To be completed by all new patients and any patient that has not had an appointment in a year or this calendar year.

Para ser completado por todos los nuevos pacientes y cualquier paciente que no ha tenido una cita en un año o año calendario.

Patient History Form - Spanish ( click to view )


soundvisioncare-history-form-20140501

Patient Letter

Patient Letter ( click to view )

 


soundvisioncare-abn-01162014

Patient Advance Beneficiary Notice of Non Coverage (ABN) - English

To be completed by all new patients and any patient that has not had an appointment in a year or this calendar year. To be completed also by any patient who has had a change in insurance or benefits.

Patient ABN Form - English ( click to view )
 



soundvisioncare-spanish-abn-07092014

Patient Advance Beneficiary Notice of Non Coverage (ABN) - Spanish

To be completed by all new patients and any patient that has not had an appointment in a year or this calendar year. To be completed also by any patient who has had a change in insurance or benefits.

Para ser completado por todos los nuevos pacientes y cualquier paciente que no ha tenido una cita en un año o año calendario. Para ser completado también por cualquier paciente que ha tenido un cambio en el seguro o beneficios.

Patient ABN Form - Spanish ( click to view )


soundvisioncare-cls-agreement

Contact Lens Agreement

For any patient wishing to have a Contact Lens Exam - To be completed each year.

Contact Lens Agreement ( click to view )

 


soundvisioncare-gvss-agreement-form

Gentle Vision Shaping System Agreement

For any patient in need of a Gentle Vision Shaping Exam - To be completed each year.

Gentle Vision Shaping System Agreement ( click to view )

 


soundvisioncare-amsler-home-test

Amsler Home Test

For any patient with a Macular Condition to monitor their central vision.

Amsler Home Test ( click to view )


 


soundvisioncare-notice-of-privacy-practices

Notice of Privacy Practices

Notice of Privacy Practices ( click to view )




 


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