Patient Information - Forms

We ask all our new patients to fill out these two forms before their first appointment. Simply click on the links below, print the forms and fill them out before your first visit to Miramar.

Note: You will need Adobe Acrobat Reader to view these forms. If you do not have Adobe Acrobat Reader, you may download it by clicking on the icon below.

Financing

Miramar Eye Specialists Medical Group is now offering financing through Citi Health. Approval for financing will be processed through surgery schedulers as the financing will be for surgery procedures only. We are offering the following programs:

3-month payment plan no interest minimum $250
6-month payment plan no interest minimum $750
48-month payment plan 12.96 interest minimum $1,250

Additionally, surgeries that are scheduled at Miramar Eye Specialists Medical Group will have the ASC fees financed as well. For more information, refer to surgery scheduler or Elizabeth.

 

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