If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site

WARNING

You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]
887 Old Country Road Suite K-L Riverhead, NY 11901
631-727-2858
m

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 )




 


Download the Free AdobeReader®