New Patients are Always Welcome
We welcome new patients! There is no substitute for a personal recommendation, and we invite you to tell your family, friends, neighbors, church-members and loved ones about us. They are always welcome. We thank you for allowing us to serve your eyecare needs.

Please download the forms below using Adobe® Acrobat Reader, print and fill out to the best of your knowledge.
1.) Patient Information Form
2.) Medical History Sheet
3.) HIPAA Notice of Privacy Protection
4.) Financial Policy

Financial Responsibility
Here at Falgoust Eye Medical and Surgical, we are committed to our patients and want them to fully understand their financial responsibilities. An office financial policy form will be issued and explained to you when you arrive.

Confidentiality
Here at Falgoust Eye Medical and Surgical, we are committed to treating and using protected health information about you responsibly. A Notice of Privacy Policies describing the personal information we collect, and how and when we use or disclose that information will be issued to you when you arrive. This notice is effective April 14, 2003, and applies to all protected health information as defined by federal regulations.

Cancellations
Please notify us as early as possible if you are unable to keep your appointment.