‘KIDS’ NEW PATIENT FORMS

If the child is 16 or older please use the adult New patient forms

Please click the below link for our New Patient Form for kids:

• KIDS NEW PATIENT FORMS (PDF format)

  • + Please Do not print double-sided +

• Simply print out the New Patient forms, fill in the information requested, and bring the completed forms with you to the appointment.

THE FORMS INCLUDE:

• Welcome Letter

• Office Policy For Minors

• Patient information form

• Disclosure of personal health information

• Notice of privacy practices

ATTENTION PATIENTS WHO FORMALLY SAW
DR. ENGLERT AT THE EYE GROUP IN EVANSVILLE:
ALL BILLING WILL NOW BE PROCESSED THROUGH DR. ENGLERT’S MAIN JASPER OFFICE, SOUTHERN INDIANA EYE ASSOCIATES. THE JASPER OFFICE ONLY ACCEPTS MEDICAL INSURANCE, SO VISION PLANS WILL NO LONGER BE ACCEPTED. THERE ARE SOME INSURANCE PLANS THAT WERE ACCEPTED AT THE EYE GROUP THAT SOUTHERN INDIANA EYE ASSOCIATES DOES NOT ACCEPT. PLEASE CONTACT YOUR INSURANCE COMPANY TO MAKE SURE WE ACCEPT YOUR MEDICAL INSURANCE.

CALL OUR JASPER OFFICE AT 812-482-6424 or 800-599-9590 WITH ANY QUESTIONS.