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Patient Forms

Consulting Ophthalmologists’ new patients are required to fill out a Patient Information form, Medical History and Medication List prior to delivery of services. For your convenience, please feel free to click on the link below to complete the necessary information on-line.  The information will be sent directly to our office through a secure website.

New Patient Online Registration

PLEASE NOTE: 

  • The submission of your on-line information should be completed at least 24 hours prior to your appointment.  
  • Our on-line patient registration service is unavailable between 12:00 AM – 5:30 AM, daily for maintenance; Or if you would prefer, you can print and fill out the PDF forms to bring with you to your first office visit.
  • Once you have submitted your registration, a confirmation code will appear on the screen.  Please bring this code with you to your initial visit. In the unlikely occurrence that we do not see your registration this will allow us to re-queue it.

Please be assured that all information provided to us electronically via the online registration link is secure and protected and meets all HIPAA regulations.

Medical Records Request: 
You may print out the “Authorization for Release of Medical Records” form above and either mail, fax or email it to our Medical Records Department.

Patient Information

Quick Contact Form

Do not use the above contact form or email address to submit confidential, sensitive, or privileged information. The information submitted on this form is not privileged. Any information submitted over the internet poses a risk that the information could be intercepted, viewed or retrieved by a third party. If you are unsure please contact us by phone as an alternative.
Farmington Office

499 Farmington Avenue, Suite 100
Farmington, CT 06032
Office Telephone: 860-678-0202

Glastonbury Office

704 Hebron Avenue, Suite 200
Glastonbury, CT 06033
Office Telephone: 860-678-0202