Patient Forms

We provide all of our new patient forms online so you can complete them in the convenience of your own home.

• New Patient Information (en Español)
• Referral Form for Referring Providers
• Authorization for Release

1. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download it for free.
2. Click on the necessary form, print it out and fill in the required information.
3. Please bring your printed and completed forms with you to your appointment and save time on your visit!

Financing Information

Metrolina Eye Associates offers financing through Chase Health Advance with 24-month no-interest plans available. Chase Health Advance offers flexible and affordable financing options.

A simple, quick and confidential application process can be done online or by phone. You will be asked to provide our Provider Merchant ID#, which is 31290 for our Monroe location and 32093 for our Matthews location.

Just click below to start your online application process.
www.chasehealthadvance.com

To apply by phone and receive your credit decision while on the phone, dial 1-800-510-5638.

Monroe, N.C. location Merchant I.D. is #31290
Matthews, N.C. location Merchant I.D. is #32093