(602) 279-2434
  • Make a Payment
  • Directions

Eye Surgery Center At The BiltmoreEye Surgery Center At The Biltmore

  • For Patients
    • Keeping You Safe During COVID-19
    • Patient Forms
    • Insurance and Billing
    • FAQs
  • Physicians
  • Our Procedures
  • Conditions
  • About Us

Patient Forms

At Eye Surgery Center at the Biltmore, your time is as valuable to us as it is to you. We encourage you to take time to download the forms and complete these before arriving on day of surgery, so that we may care for you promptly.

Patient Health History Form

*Please make sure to complete and print/email this form when registering with our center.

Download

Policy of Advanced Directive

Download

Patient Rights and Responsibilities

Download

Patient Acknowledgement

Download

Patient Privacy Notice

Download

Medication List

Download
Keeping You Safe During COVID-19 Patient Forms Insurance and Billing Frequently Asked Questions Concerning Eye Surgery
  • Contact Us
  • Notice of Nondiscrimination
  • Notice of Privacy Practices
  • Terms of Service
  • Internet Privacy Policy
  • Billing Disclosure

Eye Surgery Center at the Biltmore
2222 East Highland Avenue, Suite 101,
Phoenix, AZ 85016

© 2023 Eye Surgery Center At The Biltmore