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Patient Paperwork - EyeSite of the Villages

Patient Paperwork - EyeSite of the Villages 2026

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The document is a patient intake form for EyeSite, an optometric practice located in The Villages, Florida. It includes sections for personal information, medical history, insurance details, and consent forms related to eye examinations and privacy practices. Key components include a medical questionnaire, options for pupillary dilation and retinal imaging, and a lifetime patient consent form outlining rights under HIPAA.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information in the designated fields, including your name, date, address, and contact numbers. Ensure accuracy for effective communication.
Complete the medical questionnaire by answering 'Yes' or 'No' to each condition listed. This section is crucial for your healthcare provider to understand your medical history.
In the social history section, indicate your tobacco, alcohol, and drug use status. This information helps in assessing overall health.
Review the pupillary dilation and retinal imaging sections carefully. Select your preference regarding these procedures and provide your signature where required.
Finally, fill out the lifetime patient consent form by acknowledging your rights under HIPAA and listing any family members who may access your medical information.

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Is exam with dilation as necessary?

In determining whether eye dilation is necessary for you, your eye doctor may consider: Your age. The risk of eye diseases increases with age. The National Eye Institute recommends a dilated eye exam once every one to two years if youre 60 or older.

Why do they dilate your eyes for eye exam?

Dilating your pupil lets more light into your eye just like opening a door lets light into a dark room. Dilation helps your eye doctor check for many common eye problems, including diabetic retinopathy, glaucoma, and age-related macular degeneration (AMD).

Is it necessary to dilate?

Answer: A dilated eye exam is not typically needed to get an accurate prescription during refractive testing. Farsighted (hyperopic) persons are the exception and may need dilation to obtain the most accurate prescription.

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Can you legally drive after having your eyes dilated?

There is no specific period of time that a person must wait before driving after having their eyes dilated; the decision to drive after an eye exam is a personal choice.

Is dilation required in Florida?

Florida law requires all Board Certified Optometric Physicians to include pupillary dilation as a part of a NEW Comprehensive Eye Exam.

Can I say no to eye dilation?

In summation, dilation is not required when coding for a comprehensive eye exam following CPT guidance. However, it is the standard of care and should be performed unless the patient explicitly refuses it, and that reason should be documented in the chart.

Patient Paperwork - EyeSite of the Villages 2026

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