Forms, Literature and Printable resources

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Want to get a head-start on your paperwork? Here are Reception forms and Policies you can fill out and print ahead of time (you will be asked to fill out a welcome sheet, HIPAA form and cancellation/no-show policy agreement if you are a new patient or have not been seen within the last year):

Welcome sheet (demographics information)

HIPAA form (Health Insurance Portability and Accountability Act)

Cancellation / No-show policy agreement

SMO HIPAA overview

SMO Red Flags Rule policy

Incoming records release request (use this if you want to request records from a previous doctor sent to SMO)

Outgoing records release request (use this if you want your SMO records sent to another doctor)

Consent for Treatment of a Minor Patient (for SMO to see your minor child without a parent/legal guardian present)

 

Useful resources for reference and monitoring:

Amsler Grid: Used to monitor changes in your central vision due to macular degeneration, an epiretinal membrane, etc.

Amsler Grid

Post-op cataract instructions with drop reminder worksheets:

Cataract surgery with name brand eyedrops

Cataract surgery with generic eyedrops

Cataract surgery and glaucoma laser with name brand eyedrops

Cataract surgery and glaucoma laser with generic eyedrops

Low vision

Directory of low vision rehabilitation specialists in Michigan