Pediatric & Adult Ophthalmology
Specialty Eye Care With A Family-Friendly Approach

Worker's Compensation Forms

There are THREE forms that all patients with a worker's compensation claim are required to complete for our office.  Please download and print each form and fill in all required information.  Bring the completed forms with you to your appointment. 

These three forms will require Adobe Acrobat (free program) to open, view and print them.

Worker's Compensation Information Form

A9 (4-04)

HIPAA-1 (12-03)