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1-866-314-EYES (3937)
1-866-760-OJOS (6567)

We would like to welcome you as a patient to Mid-Atlantic Eye Physicians. After scheduling your first appointment, we will need to know a few things about you and your medical history. You will find here several forms that will help us in treating you.

In an effort to save time on your first visit, please follow the instructions below.

1. Print the forms from your home computer.

2. Fill them out completely

3. Bring them with you.

Please also remember to bring your insurance card. We accept most major insurances including Medicare and Medicaid of North Carolina and Virginia. Please call to verify if we accept your plan.

We ask that you arrive 15 minutes prior to the time of your appointment. Also, please allow 2 hours for your first visit with us, as your eyes will be dilated. You will experience light sensitivity and blurred vision due to the dilation. We suggest that you bring sunglasses and a driver.

It is very important that you bring all current medications with you so the doctor will be well informed of your medication status.

If you have any questions, please don’t hesitate to call our office. The telephone number for our Roanoke Rapids office is (252) 537-8193 and our South Hill office is (434) 447-2255. If you are out of the calling area, please use our toll-free number which is 1-800-999-7590.

New Patient Forms