Patient Registration Form

HIPAA RIGHT OF ACCESS FORM FOR
FAMILY MEMBER/FRIEND

If you would like to give permission for a friend or family members to access your medical information, please complete this form below and bring a copy with you to the office on your appointment day.


Health Information to be disclosed upon the request of the person name above-- (Check either A or B):

OR

OR

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Our new patient registration form and other popular forms are available online for your convenience.

EyeSmart® »

EyeSmart® program provides you with trusted information about eye health. Learn about eye diseases and conditions, how to protect your sight and more from the American Academy of Ophthalmology

Careers »

Current job openings and a preliminary employment application

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Tell us about your experience and read what others are saying about St. Lucie Eye's physicians and staff

  Our Locations

Ft. Pierce
2201 S. 10th St.
Ft. Pierce, FL 34950
(772) 461-2020
FAX: (772) 468-2134
Port St. Lucie
1302 SW St. Lucie West Blvd.
Port St. Lucie, FL 34986
(772) 340-2929
One Day Surgery Center
1715 SE Tiffany Ave.
Port St. Lucie, FL 34952
(772) 905-3422
Click here for details
Port St. Lucie
1715 SE Tiffany Ave.
Port St. Lucie, FL 34952
(772) 335-3939