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Patient Information

Forms

Patient Registration Forms:

Patient Registration
Office & Financial Policies
HIPAA Form
Notice of  Privacy Practices
Medical Records Release
Medical History Questionnaire

Medical Forms:

Information for Avastin/Lucentis Injections

If you have any questions about this Notice, please contact our office.

Privacy Information

Raleigh Ophthalmology is committed to protecting patient privacy. Please review the following materials to learn how we protect your personal information, how your information may be used or disclosed under federal law, your rights under federal law, and much more.

Accepted Insurance

While we attempt to keep our site up to date, if you have questions regarding coverage, please contact us.

  • AARP
  • AARP MEDICARE COMPLETE
  • AETNA
  • AETNA MEDICARE
  • BCBS
  • BCBS FEDERAL
  • CIGNA
  • EVERCARE
  • FIRST HEALTH
  • HUMANA
  • MEDICARE
  • MEDICAID
  • MEDCOST
  • SECURE HORIZONS
  • STATE HEALTHPLAN
  • TRICARE (For Life & Standard)
  • UNITED HEALTHCARE
  • WELLPATH

Medical Records Request

Raleigh Ophthalmology’s Release of Medical Information form can be used to request a copy of your medical records for legal reasons or to transfer records to another physician. The physician can not release your medical records without your written consent unless required by court order. To start your request, simply download, print, complete and sign the following forms and fax or mail them back to us, attention “Medical Records”. Processing copies of transfers of medical records is subject to a $ 15 administrative fee.

RALEIGH OPHTHALMOLOGY (Medical Records)
2709 Blue Ridge Road Suite 100
Raleigh, North Carolina 27607

Medical Records Release