Anderson & Shapiro Eye Care
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Patient Forms

by Anderson & Shaprio

We’ve gathered some of the more useful forms you might need for us and notices that can impact your care. Please call us at (608) 827 – 7705 if you have any questions or need something else.

Pre-Surgery Instruction Booklet

Medical Records Release Form

Patient Rights and Responsibilities Notice

Surgery Discharge Instructions

Patient Financial Responsibility Form

Notice Regarding Patient Protections Against Surprise Billing

Right to Receive a Good Faith Estimate of Expected Charges Notice

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Anderson & Shapiro Eye Care
  • Home
  • About
    • About Us
    • Insurance and Finance
    • Privacy Policy
    • Locations
    • Blog
    • Careers
  • Doctors
    • Claire Cordoba, O.D.
    • Nicole Anderson-Weiss, M.D.
    • Michael Shapiro, M.D.
  • Services
    • LASIK
    • Cataract Center
    • Glaucoma Center
    • General Eye Care
    • Optical Shop
    • Educational Brochures
  • Contact Us
    • Schedule with Dr. Cordoba
    • Contact Us
    • Locations
    • Patient Forms
    • Facebook
    • Instagram
  • Pay Online
  • Patient Portal