Black Eagle Eye

Patient Forms

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Online Patient Information Forms

 

NEW PATIENTS:

Please visit our secure portal by clicking HERE.  Fill out the “Information” tab and “Medical History” tab to its entirety.  At the bottom of the “Medical History” tab, make sure you submit by clicking the gray “SUBMIT DATA” button at the very end of the page.

CURRENT PATIENTS:

Please visit our secure portal by clicking HERE.
Instructions will be provided by email on the day of your appointment on how to obtain your passcode. 
At least ONE HOUR before your appointment, please review all fields in the “Information” tab and “Medical History” tab to its entirety.   At the bottom of the “Medical History” tab, make sure you submit by clicking the gray “SUBMIT DATA” button at the very end of the page.
 
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HIPAA

To view our Notice of Privacy Practices, please download below. However, it is not necessary to print or bring a copy with you.  This is provided for your records only.

Notice of Privacy Practices (HIPAA)

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Records Release

This form is for medical records to be sent between two doctors’ offices.

Authorization for Release of Information

 
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Office Policies

To view our current office policies, please click the link below.

Office Policies

CL Policy

Good Faith Estimate

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EAGLE EYE CARE
100 Country Club Rd, Ste #120
Argyle, TX 76226