Patient Forms

New Patient Form

Welcome! If you’re planning your first visit to Richie Eye Clinic & LASIK Center, we look forward to meeting you. To save time on your first visit, we encourage you to print and fill out our new patient forms below.

If you do not already have AdobeReader® installed on your computer, Click Here to download.

  • Download the necessary form(s), print it out and fill in the required information.

  • Complete your forms and bring them in with you to your appointment

Records Release Forms

My Secure Health Forms

  • My Secure Health Sign-Up Form

  • My Secure Health Adult Proxy Form

  • DOWNLOAD​​​​​​​

Surgery Center Forms

  • Crossroads Surgery Center Bill of Rights

  • Crossroads Surgery Center Health Care Directives

  • DOWNLOAD​​​​​​​

Privacy Policy