Personal Representative Authorization for Medical Release (English)
Thank you for choosing Eye Physicians & Surgeons of Arizona.
This form is divided into 4 sections. Please fully complete all sections.
Please bring the following to your appointment:
- Photo ID
- Insurance Card
- List of Medications (if any)
Anyone attending the appointment will be required to wear a face mask.
For cataract evaluations, please remove soft contact lenses at least 48 hours prior to your appointment and please remove hard lenses (gas permeable) at least 2 weeks prior to your appointment.
If you have any questions, please contact our office.