Download an electronic copy of our most recent "The Eye Opener" newsletter.

Please print these forms and complete before your appointment. The first two pages are the patient history forms used by all our patients to list their name, address, insurance information, medical and eyecare history, medicines used, etc. The third page is a required HIPPA (Notice of Privacy Practices) form to be signed after reading the privacy notice either in our office or on the bottom of this web site's home page. Thanks for helping us more efficiently serve you at our office.

Use this form to authorize Medical, Vision, and/ or Medicare benefits to Drs. Buckingham or Kaminski for services/ goods furnished to me.

Use this form to have another office release your records to our office or to have your records released from our office to another provider/ entity.

Quick reference guide/ patient handout. Daily intake of these nutrients through foods and/or
supplements has been linked to healthy eyes and may
reduce risk of some chronic eye conditions. Consult your doctor, nurse or pharmacist before starting or changing supplemental nutrients.