Patient Forms

We have a comprehensive packet of Patient Forms for you to review and complete. Prior to visiting our office, we encourage you to fill out all the required Patient Forms. It will help us to expedite the administrative tasks during your visit, which means we can focus on your eye care more efficiently!


Please review our HIPAA Policy.

Carolina Ophthalmology HIPAA Privacy Practices

We encourage you to print and complete these forms.

Patient Information Form

Patient History Form

Consent Form for Minors

Authorization to Release Health Information

Assignment of Benefits

Financial Policies Form

Enjoy Life! With better Vision

Stop struggling with your eyesight! Now is the time to schedule your cataract evaluation with Dr. Penke at Carolina Ophthalmology. Why not take our Self Evaluation Test to get started?

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