Thank you for choosing The Eye Center of Southern Indiana for your eye care.   We appreciate the opportunity to serve you and look forward to meeting you.

Patient Registration

Patient Registration Form (download)
Medical History Form (download) 

Prior to Your Appointment:

Please complete and print the registration and medical history forms even if you are an established patient. Once you have completed the forms, please bring them with you on the day of your appointment.  Due to HIPAA privacy concerns, please do not attempt to send these forms to our office via e-mail.

Please check with your insurance company(s) to verify your medical coverage for routine eye examinations by calling the customer service phone number listed on your insurance card.  

If you have a medical clinic listed on your insurance card, you will need to call its referral department to determine if an insurance referral is required for coverage of your eye examination, medical visit, or procedure.  If you need further information to process this referral please call (812) 334-1213 and ask to speak to our insurance coordinator.

Should you need financial assistance for your services, please call our office before your visit to find out what options are available to you.  The insurance and billing office is available Monday - Friday from 8:00 a.m. until 5:00 p.m. at (812)353-6467.