New Patient Info
“ Come see how affordable QUALITY eye care can be ! “
NEW PATIENT REGISTRATION
We are honored that you selected us to be your eye care provider. As a new patient, please bring any current glasses, medicine list and insurance card(s) at the time of your visit. We ask that you arrive 15 minutes before your appointment. To streamline your checking in, we have placed your registration forms on-line. One is a our HIPAA compliant consent form while the other is our history form. Please print, complete and bring them with you at your first visit with us.
Use your browsers back key to return to this page after you select and print your form.
In 1996 the US Congress passed legislation creating the Health Insurance Patient Portability Act (HIPAA) to protect the privacy rights of patient information. To view our privacy practices, please download a copy of our policy.
If you do not have Adobe PDF on your computer, you can receive a free download at Adobe Reader
Dr. Joseph Audia 2403 West Main St. Salem, WV 26426 304-782-1005 Dr. Joseph Audia 345 Floral Drive Harrisville, WV 26362 304-643-2117
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