Vision Center of Delaware

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New Patients Form

The Day of your Appt.  What to expect

It is expected that you come on time for your appt. more than 15 minutes late we must reschedule your appt.

If you need to reschedule we require 24 hour notice, otherwise a charge of $30.00 will be added to your account.

New patients will be dilated for the exam; make sure you bring sunglasses, and if needed a driver.

Completed New Patient Forms.

A list of all medications and eye drops that you are currently taking.

Any contact lenses or glasses that you currently wear.

Take the time to look around at our selection of frames, if you see something that interest you do not hestitate to 

ask questions, we are here to help and educate you on your eye health.

Your current Medical and Vision insurance cards and Drivers License or Photo I.D.

Referrals from your primary care physician if your insurance requires a referral to see a specialist. 

NOTE: Without a proper referral, payment will be due at the time of the office visit.

Workers Compensation:  Payment due at time of service.

Requesting Medical Records

Your records will be released upon receipt and payment of the 

signed Medical Record Release form.

You can request records from Vision Center of Delaware upon filling out a records release form either by mail, phone or email.

Fax, email, or bring completed form to Vision Center of DE. 

Processing Cost$15.00  Please allow up to 10 business days to process your request.

Authorization Signature for Your Records Release

By law, the following authorized people are able to sign for the release of your health information:

Yourself  (not your spouse) A parent  (for patients younger than 18 years of age) Legal guardian (guardianship documentation is required) Power of attorney if patient is unable to sign (legal documentation is required) Estate representative for a deceased patient (estate documentation is required) 

These parameters follow Delaware State laws. 
Board of Medical Licensure and Discipline Section 16.0