Welcome to the Eye Center of Texas online patient forms library. We’ve organized the documents into three categories for your convenience. The forms are easy to open and can be printed or saved to your computer – here’s how:
- Click on a category bar below to show/hide the medical forms in that group.
- Click on the desired form, it will open in a new tab or new window in your browser.
- Save or Print the document using the Adobe tool bar immediately above the form.
- To exit the form, just close the new tab or new window it is showing in.
Note: The forms are in Adobe PDF format.
Patient Medical Forms
Lifestyle Vision Questionnaire – English
Lifestyle Vision Questionnaire – Spanish
Medical History Form
Medical History – Spanish
HIPAA – English
HIPAA – Spanish
Visual Assessment Questionnaire – English
Visual Assessment Questionnaire – Spanish
Pharmacy Form – English
Pharmacy Form – Spanish
Notice of Privacy Practices
Maps to all ECT Locations and Patient Education Documents
Clear Lake Map
Sugar Land Map
Cornea Transplant – What Is It?
Glaucoma – What Is It (English)
Glaucoma – What Is It (Spanish)
LASIK – Frequently Asked Questions
LASIK – Drivers License Change After LASIK
LASIK – Pre – Operative Instructions for Patients
Trabeculectomy – What Is It?
Vitamins & Food Supplements Chart
For your convenience, parking at all our locations is free. Some of our patients are very ill; therefore we ask that you do not bring children to your appointment. If you absolutely must bring children, please bring something along to quietly occupy the time, since your appointment may last one to two and a half hours.
To avoid a delay in your appointment time, please print out and fill out the forms below and bring them with you to your appointment.
Since you are responsible for payment for our physician’s services and any testing done during your visit, please call Eye Center of Texas at 713-797-1010 (ask for the insurance department) with your insurance information. Our insurance person must have your social security number, date of birth and the name of the insured person; if insurance is through your spouse’s employment, that person’s date of birth and social security number. With this information, we can verify your insurance prior to your appointment day. If you gave insurance information to Eye Center of Texas when you made your laser vision correction appointment, you don’t need to call.
If your insurance carrier is an HMO, you must contact your Primary Care Physician (PCP) who is listed on your insurance card and ask for an insurance referral. If you are not sure about your benefits, call your insurance company (phone number on your insurance card) to find out. We regret that if we do not have your insurance referral from your PCP on your appointment day, we must reschedule your appointment. According to the law (HIPAA) and our office policy, we cannot call your PCP for you.
We appreciate your choosing Eye Center of Texas for your medical/surgical eye care, and we look forward to meeting you.
“Food and drinks are not allowed in the office.”
“Our medical and surgical lasers are adversely affected by cell phone transmissions. Please remember to turn off all cell phones while at our office.”
Houston6565 W. Loop S., Suite 650
Bellaire, TX 77401
Pasadena4415 Crenshaw Road
Pasadena, TX 77504
Sugar land15400 S.W. Freeway, Suite 301
Sugar Land, TX 77478
Clear Lake455 E. Medical Center Blvd., Suite 110
Webster, TX 77598
KatyKingsland Medical Plaza 777 S. Fry Road, Suite 102
Katy, TX 77450
The Woodlands/Conroe100 Medical Center Blvd., Suite 118
Conroe, TX 77304