​Dr. Smith's Eye Care & Optical
  • Home
  • About Us
    • Our Doctors
  • Our Services
    • Comprehensive Eye Exams
    • Dry Eye Testing
    • Contact Lenses >
      • Contact Lens Policy
    • Retinal Imaging
    • Glaucoma Screening
  • Patient Resources
    • About the Portal
    • Request Appointment
    • Forms
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    • First Visit Information
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    • Jefferson Office
    • Leo Butler Center
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Electronic Patient Forms

Patient Forms For Existing Patients
​New Patients, Please Call Our Office

*Electronic forms may take a few additional moments to load

               

Printable Patient Forms

Registration Form
HIPAA Compliance
Medical Records Release
​
​[NOTE: This PDF requires a free plugin that may have come included with your browser. If you are having difficulties opening this file Click Here to go to Adobe's web site for Acrobat Reader.]
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​Dr. Smith's Eye Care & Optical

JEFFERSON OFFICE
12656 Jefferson Hwy
​Baton Rouge, LA 70816
LEO BUTLER COMMUNITY CENTER
950 E. Washington St.
​Baton Rouge, LA 70802
Phone: (225) 751-4100
contact@drsmithseyecare.com
Copyright © 2021
  • Home
  • About Us
    • Our Doctors
  • Our Services
    • Comprehensive Eye Exams
    • Dry Eye Testing
    • Contact Lenses >
      • Contact Lens Policy
    • Retinal Imaging
    • Glaucoma Screening
  • Patient Resources
    • About the Portal
    • Request Appointment
    • Forms
    • Insurance
    • First Visit Information
  • Contact Us
    • Jefferson Office
    • Leo Butler Center
  • Patient Portal