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Patient Information

Forms


Patient Registration Forms:

HIPAA Form
Medical Records Release
Medical History Questionnaire


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
  • BLUE CROSS BLUE SHIELD
  • BLUE CROSS BLUE SHIELD FEDERAL
  • CIGNA
  • EVERCARE
  • FIRST HEALTH
  • HUMANA
  • MEDICARE
  • MEDICAID
  • MEDCOST
  • SECURE HORIZONS
  • STATE HEALTH PLAN
  • 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 form and mail or fax them back to the attention of “Medical Records.”  Processing copies or transfers of medical records are subject to a $15 administrative fee, and can be paid by check or money order when mailing in release requests to ensure prompt fulfillment.

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

Medical Records Release


Patient Portal 

To sign up for our patient portal, please follow the link below for instructions. 

Patient Portal Registration