The Great EyeDeal
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"For many years as Vice President of Professional Services at Cole Vision, I partnered with the good folks at Great Eyedeal to provide our affiliated ...."  more
- Michael L. Cohen
O.D., F.A.A.O.
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Patient Forms
Various Practice Management Forms used during routine examinations. These forms meet all the requirements set forth by the Health Insurance Portability and Accountability Act (HIPAA). According to the HIPAA certification we are compliant with the requirements relating to privacy, confidentiality and security of individually identifiable health information.
Contact Lens Forms
- CL2 Contact Lens Form Lg
- Contact Lens Care And Handling Agreement
- Contact Lens Wearer Card

Eye Exam Forms
- 5Pt. Rx3 Large W/O Guara./1000
- Comprehensive Eye Exam Form w/ Contact Lens
- Comprehensive Eye Exam Form w/o Contact Lens
- Reading Card-English Version For Near Vision
- Reading Card-Spanish Version For Near Vision
- Supplementary Exam Card #2

Health/History Forms
- Contact Lens History Card

HIPAA Form
- English HIPAA Consent Form, Full Size
- English HIPAA Consent Form, Small Size
- HIPAA Access to Records Form
- HIPAA Acknowledgement of Receipt Notice
- HIPAA Auth for disclosure of personal health information
- HIPAA Complaint Form
- HIPAA Notice of Privacy Practices

Miscellaneous Forms
- 2008 Appointment Book
- Dilation Consent Form
- H-200
- Patient Record Release
- Request For Out-Of-Date EyeGlass Prescription

Patient Referral Forms
- Contact Lens Patient Referral
- Patient Referral And Consultation Form

Standard RX Forms
- Doctor Complete Rx
- Generic LifeStyle Rx With Contact Lens
- Generic LifeStyle Rx without Contact Lens
- Prescription Form- For Spectacles Contact Lenses
- Prescription Pad-TPA

Great Eye Deal Please call 1-888-480-4835 ext. 117 between 8:00 AM and 5:00 PM CST. Mon. - Fri.
Voice mail available. All calls returned within 2 hours or less.
customercare@greateyedeal.com : www.greateyedeal.com : 1-800-422-2903 (fax)
Great Eyedeal 12100 Ford Road, Suite 100, Dallas, TX 75234