Atlantis Eyecare knows how important it is to you to ensure you receive your patient chart notes. If you did not receive your chart note or need appointment status for your patient, please fill out this request form below. Our Physician Relations Department will investigate why you did not receive these notes and send you these notes immediately.
If you should have any questions, please contact our Physician Relations department at (714) 956-4300 or email referrals@atlantiseyecare.com.
Below are links to download our new patient forms in both english and spanish. If you would like to save some time you can click on the link to print them out and bring them to us on your visit. We look forward to seeing you soon.
| Patient Forms | ||
|---|---|---|
| New Patient Packet | English | Spanish |
| Welcome Form | English | Spanish |
| Locations Map | English | Spanish |
| Medical Information Form | English | Spanish |
| Patient Registration Form | English | Spanish |
| Government Form | English | Spanish |
| HIPAA | English | Spanish |
| Authorization for Use and Disclosure | English | Spanish |
| Lifestyle Questionnaire Form | English | Spanish |
