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Home » Patient Resources » Patient Forms

Patient Forms

As a courtesy to our patients, we’ve made available these helpful forms and information packets. Simply click on the links below to view each PDF.


Important: You must have an Adobe Acrobat Reader:

 

General Information

Follow Up Patient Packet

Follow Up Patient Packet (Spanish)

Medical Record Release Form

New Patient Packet

New Patient Packet (Spanish)

Photos and Videos

Taking Standardized Photos at Home

TED Videos Instructions

Accepted Insurance

Dr. Soparkar Houston Texas Insurance

Dr. Patrinely Houston Texas Insurance

Dr. Patrinely Florida Insurance

Dr. Murdock Houston Texas Insurance

COVID-19 Forms

Viral Infection Risk Assessment

COVID-19 Risk Awareness

Patient Consent Forms

LATISSE Consent Form 2020

Telemedicine Consent

 

 

Patient Resources

 

Latest News

Events and Specials

Financial Policy

Patient Education

Patient Forms

Patient Links

Patient Portal

Patient Testimonials

Products

Publications

Thyroid Eye Disease Video Series

Patient Reviews

Find out what our patients say about us or write your own review.

Review Us

 

Schedule an Appointment Today

Please download our Brochure

Reconstructive

Cosmetic

Patient Resources

Schedule Appointment

 

Blepharospasm Treatment

Corrective Plastic Surgery

Earlobe Surgery

Ectropion

Entropion

Eyelid Reconstructions

Eyelid Skin Cancer

Orbital Trauma

Orbital Tumors

Ptosis

Thyroid Eye Disease

Tearing

 

Blepharoplasty

Droopy Eyelid

Forehead Lift

Injectables

Lower Eyelid Lift

Upper Eyelid Lift

Male Blepharoplasty Photos

Female Blepharoplasty Photos

Latest News

Events and Specials

Financial Policy

Patient Education

Patient Forms

Patient Links

Patient Portal

Patient Testimonials

Products

Publications

Thyroid Video Resources

Experience Counts.

Plastic Eye Surgery Associates, PLLC has performed over 150,000 Eye and Facial Procedures.
Experience you can count on!

For Appointments in Texas

Call (713) 795-0705

For Appointments in Florida

Call (850) 473-0990

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 Houston Office

Plastic Eye Surgery Associates
3730 Kirby Drive, Ste. 900
Houston, TX 77098
Phone: (713) 795-0705
Fax: (713) 807-0630

View Map & Hours

Destin Office

Plastic Eye Surgery Associates
4012 Commons Drive West
Suite 110
Destin, FL 32541
Phone: (850) 473-0990
Fax: (850) 473-0790

View Map & Hours

Pensacola Office

Plastic Eye Surgery Associates
17 E. Main St. Suite 100
Pensacola, FL 32502
Phone: (850) 473-0990
Fax: (850) 473-0790

View Map & Hours

The Woodlands Office

 

Plastic Eye Surgery Associates

128 Vision Park Blvd. Suite 150
Shenandoah, TX 77384

 

Memorial Hermann Medical Plaza IV

9180 Pinecroft, Suite 250
Shenandoah, TX 77380

Phone: (713) 795-0705
Fax: (713) 807-0630

View Map & Hours

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