“Trust Your Eye Care to a Specialist”

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Patient Forms

New Patient Information

Preparing For Your Visit
For your convenience, the forms required for your initial visit to our practice are listed below. We encourage our patients to print each form and fill in the required information. Please bring the forms with you to your appointment.

Adult Patients

Please complete the Medical History Form.

Please complete the New Patient Questionnaire.

Please Read the Notice of Privacy Practice
Please Complete the Receipt of Notice of Privacy Practice

Pediatric Patients

Please complete the Pediatric Medical History Form.

Please complete the New Patient Questionnaire.

Please Read the Notice of Privacy Practice
Please Complete the Receipt of Notice of Privacy Practice


Please download a copy of the Medical Record Release Form

Please download a copy of the insurance providers we accept.

These forms require the Adobe Acrobat Reader software. If you are unable to open the files, try downloading the free software at www.adobe.com/products/acrobat/readstep.html


You should also bring the following items when you come for your appointment:

  • your insurance or health coverage card(s)
  • a list of any eye drops or other medications that you are currently using
  • your eyeglass and/or contact lens information (bottles or boxes in which the contact lenses are packaged)


Obtaining Insurance Authorization
Please be sure to obtain authorization from your insurance provider prior to your appointment. If you have a question regarding obtaining authorization for your visit, don't hesitate to call our office and ask for Patient Services. We would be happy to assist you in any way that we can.

Information to Keep in Mind
Comprehensive eye examinations normally require one to one-and–a-half hours for new patients. Dilation of your pupils may be required for the examination. As the effect of dilation can take a few hours to wear off, it is best that you do not plan to drive or read immediately after the appointment. Ocular evaluations may also include visual field testing, optic nerve analysis and possibly other specialized corneal or glaucoma testing. These tests may require more time to complete.

Any required co-payments and deductibles will be collected from you as indicated by your health plan. Payment is requested at the time of the visit for any co-payments, deductibles, or services not covered by your health care plan. Payment may be made by cash, check, MasterCard, Visa or Discover.


Why Choose CEI?

Coastal Eye Institute (formerly Manatee Sarasota Eye Clinic) is one of the area’s largest ophthalmology practices featuring a comprehensive team of fellowship-trained ophthalmologists in every subspecialty of eye care.From infancy to the golden years...we provide care for the total health of your eyes. Trust your eye care to our specialists!


Coastal Eye Institute has fellowship-trained ophthalmologists in every specialty of eye care:

  • ➢ Laser Cataract Surgery
  • ➢ Glaucoma
  • ➢ Macular Degeneration
  • ➢ Diabetic Retinopathy
  • ➢ Dry Eye Disease
  • ➢ LASIK Laser Vision Correction
  • ➢ Neuro-Ophthalmology
  • ➢ Pediatric Eye Care
  • ➢ Routine Eye Care
Schedule an Appointment

We are happy to work with your busy schedule! With nine physicians and four offices, we are confident we can find a time, day and location that is convenient for you. Call 941-748-1818 and let us help you on your way to seeing more clearly!


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