New Era Eye Care

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • The e-mail address will be used as your login ID to gain access to your exam and treatment information via the secure patient portal.
  • Patient Record Uses and Disclosures

    In general, the HIPAA privacy rule gives individuals the right to request a restriction on uses and disclosures of their protected health information (PHI). The individual is also provided the right to request confidential communications or that a communication of PHI be made by alternative means such as sending correspondence to the individual's office instead of the individual's home.
  • People whom your Medical Information can be disclosed if requested (i.e. Doctor, Spouse, Parents):

  • Please List All Current Medications With Dosage