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Patient Paperwork - EyeSite of the Villages 2026

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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.