Atlantis Vision Center
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Patient Forms

Please fill out the following patient information forms and bring them with you to your first visit. Signing "Acknowledgment of Receipt of Privacy Practices" on the form signifies that you have read the Privacy Policy, listed below.
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New Patient Medical History FORM
financial agreement FORM
NO SHOW/CANCELLATION POLICY FORM
​[NOTE: This PDF requires a free plugin that may have come included with your browser. If you are having difficulties opening this file Click Here to go to Adobe's web site for Acrobat Reader.]
PROTECTED HEALTH INFORMATION RELEASE FORM
PATIENT RELEASE OF RECORDS TO ATLANTIS
REFRACTION/DILATION FORM
PATIENT RELEASE OF RECORDS FROM ATLANTIS
Notice of Privacy Practices


Insurances we accept
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ATLANTIS VISION CENTER
2194 Florida A1A #109
​Indian Harbour Beach, FL  32937

HOURS
Monday: 8:30 am - 5 pm
Tuesday: 8:30 am - 5 pm
Wednesday: 8:30 am - 5 pm
Thursday: 8:30 am - 5 pm
Friday: 8:30 am - 5 pm
CONTACT US
321-777-1670

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  • Home
  • About
  • Services
  • Dry Eye Specialist
  • Order Contacts
  • Patient Forms
  • Contact Us
  • Our Videos