Patient Forms and Policies

The links below provide the forms for you to complete prior to your appointment.  We urge you to click the link and print them out to complete them as this will reduce the amount of time before you see the doctor. We prefer for you to have filled out these forms before arriving for your appointment, however you may fill them out at the office if you do not have access to a printer. If you do not know how to fill out any sections, leave them blank and we'll assist you when you arrive.​

As a covered entity under HIPAA (Health Insursance Portability and Accountability Act), All Eye Care. P.A./Rajiv M. Rugwani, M.D., is required to maintain the privacy of your protected health information. We are prohibited by law from disclosing any protected health information to anyone other than you without your written authorization. 

We highly appreciate our patients keeping their scheduled appointments. If you wish to cancel or reschedule your appointment, contact our office at least 24 hours prior to the appointment time. A $30.00 "No Show" charge will be applied if the patient cancels their appointment within 24 hours of the appointment time, reschedules their appointment within 24 hours of the appointment time, or does not show up to their appointment by their appointment time.

Forms

Policies

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