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Online Forms

Renewed Vision Registration Forms:

At Renewed Vision, we value your time. In order to expedite the registration process, we ask that new patients submit the following online form:

Welcome to our Office (submit online)

If you would rather download/print the form to bring to your appointment or fax to the office, please use the link below. AdobeReader is required to download the form. You will find a link to a free download of Adobe Reader at the bottom of this page.

Welcome to Our Office! (print)

Transfer of Medical Records:

If you would like Renewed Vision to release your medical information to another medical provider, or if you would like Renewed Vision to request your medical information from another provider, please download and fill out the appropriate form below. The following information is required per HIPAA regulations: Patient name and date of birth, specific information requested and reason for request, signature of patient or guardian. You may bring the complete form to Renewed Vision or fax it to: 706-367-1290.

Records Release Form (Request records from another office be sent to Renewed Vision)

Records Disclosure Form (Request records from Renewed Vision be sent to another office)

Renewed Vision Policies:

Notice of Privacy Practices

Financial Policy

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