Download our patient forms below. Please sign the PDF and return it to us via fax or email to the location of your appointment.

For appointments at Commonwealth, email completed forms to [email protected] or fax to (617) 236-6323. For appointments at Roslindale, email completed forms to [email protected] or fax to (617) 553-2121.

PATIENT FORMS

Authorization for Use and Release of Health Information

Acknowledgment of Privacy Practices and Consent to Treatment Form

Email Authorization Form

Medical Consent for Examination of a Minor Form

Contact Lens Fitting Policy
PATIENT POLICIES
Notice of Privacy Practices
Patient Rights and Responsibilities

HIPAA PRIVACY RULE
The HIPAA Privacy Rule (Health Insurance Portability and Accountability Act of 1996) created national standards to help protect a patient’s personal health information (PHI) and medical records and how they are transmitted electronically. NECO Center for Eye Care adheres to a strict set of practices to protect your health information and comply with HIPAA Privacy Regulations. View our Privacy Policy.