Online Forms

We would like to welcome you to Lakeside Eye Associates. In an effort to save you time during our check-in process, you can download and complete our patient forms prior to your appointment.

  • You will need AdobeReader® to download and complete the forms. Click here to download.
  • Please download the following PDF forms, save to your computer, then email to or you may print and bring with you to your appointment and/or fax to 704-896-5514.

Please complete the following 3 required forms for New and Established patients:

Authorization For Release To Family Members/Notice of Privacy Practices*

Patient History*

Insurance Coverage Disclaimer*

Optional Testing Consent Form*

If you are a contact lens wearer please also include:

Contact Fitting Agreement**

Optional forms and request:

HIPAA Privacy Agreement

Medical Records Release Form - To Lakeside Eye Associates

* Required

**Required for contact lens wearers

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We look forward to hearing from you


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