New patient paper work can be completed at the bottom of page and mailed to:
Eye Care Associates of Sarasota
1219 South East Ave #105 Sarasota, FL 34239              
                                                 (Please note that our mail can take 5-7 days to arrive, even if mailed in Sarasota)
         Be Advised: Patient paper work may be unavailable to pull  up on some apple products.

                                                You can also : FAX forms to 941-954-1835 and/or
                                           Email our office at cburr@srqeyecare.com
                                                                        
               
​​​​​​​         Keep in mind the most efficient and convenient way to fill out  your registration forms will be in the patient portal. ( The patient portal will also give you quicker access to your summary of care and any additional information you may need for other appointments).       Call our office and leave us your email address, we can send you a link to the portal.

                                     
                                                                                                                                      
                                                                     

Patient Demographics
File

Form 1

Download File
Medical History
File

Form 2

Download File
Privacy Preferences
File

Form 3

Download File
Privacy Notice
File

Form 4

Download File

Instructions for fillable forms

Forms,  Instructions for Fillable PDFs
This means that you can fill out the information required by the form by typing in the information while the form is displayed on your computer monitor.
To view, complete and print fillable forms you will need the freely available Acrobat 5.0 Reader (or later) software installed on your computer. Many computers are sold with Adobe installed already.
But if not, the Adobe Acrobat 5.0 Reader can be downloaded at http://www.adobe.com/products/acrobat/readstep2.html(link is external)
       
Completing the Fillable Form
  • Download the form by clicking on the “Download File” link.
  • Save the form to your desktop where you can easily find it.
  • Open your saved form
  • Position the hand pointer inside a form field and click. The I-beam pointer allows you to type text.   The arrow pointer allows you to select a field, a check box, a radio button, or an item from a list.
  • To accept the field change and go to the next field, press Tab or use your mouse to click on the next form field.
  • To accept the field change and go to the previous field, press Shift + Tab or use your mouse to click on the previous form field.
  • After completing the form, save it again. Then you can attach the form to an email – Please put your last name in the subject area. You could also print the fillable form and fax it to us or put it in the mail if you prefer.