​​Independent Doctor of Optometry
New Patient Paperwork
To help make your check-in process as smooth and efficient as possible, we kindly ask that you complete the New Patient Paperwork prior to your appointment.
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You can download and print the forms using the button below.
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Please bring the completed paperwork, a picture ID
and Insurance Card (If applicable) to your scheduled visit.
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If you have any questions while filling out the forms, feel free to call or text our office phone at (407) 269 - 9438
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Thank You for choosing Dr. Alexandra Vlad, O.D. LLC.
We look forward to seeing you soon.
Authorization for Release of Information
Please print and complete the Authorization for Release of Information form.
Once filled out, you may return the form to our office in person or by email
If you have any questions or need assistance with the form, feel free to call or text our clinic staff at (407) 269 - 9438.
Thank you for helping us keep your medical records up to date and secure.
Notice of Privacy Practices
Please print and review our Notice of Privacy Practices for your information.
This document explains how your personal health information is used and protected in our clinic. We recommend reading it carefully so you are fully aware of your privacy rights and our responsibilities.
If you have any questions or need more information, our staff is here to assist you.