Patient Forms & Payment Options
We provide all of our new patient forms online so you can complete them in the convenience of your own home.
Click forms below to print:
- New Patient Information (en Español)
- Pediatric Patients (en Español)
- Referral Form for Referring Providers
- Medical Records Release Authorization
- If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download it for free.
- Click on the necessary form, print it out and fill in the required information.
- Please bring your printed and completed forms with you to your appointment and save time on your visit!
Metrolina Eye Associates offers several excellent financing options with approved credit. Convenient, confidential applications are available in our office or online. One of our associates would be happy to provide you information on applying. Just ask!
- Cash, Check, Visa, MasterCard, American Express or Discover Card
- CareCredit’s Healthcare Credit Card
- No Interest if Paid in Full within 6 & 12 Months*
- 14.90% APR and Fixed Monthly Payments Required Until Paid in Full over 24, 36, 48 & 60 Months**
- Allows you to pay over time
- No annual fees or pre-payment penalties
- With CareCredit, you have a revolving credit line for repeat procedures, without the need to re-apply. It only takes a few minutes to apply for CareCredit and you may receive an online decision in seconds!