New Patient Info  

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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.

 

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New Patient History and Consent Adobe PDF icon                                                  Infant History and ConsentAdobe PDF icon

PRIVACY ACT

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. 

Notice of Privacy Practice

If you do not have Adobe PDF on your computer, you can receive a free download at Adobe Reader   Get Acrobat 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
 Send e-mail to us with questions or comments about this web site.                    Copyright 2014 Dr. Joseph Audia             Last modified: 07/07/14