New Patients

New Patient Forms

Welcome to Kaster Eye Clinic!

You may schedule an appointment at our Green office by calling or texting (330) 899-7161.

Required For All Patients

Welcome Form (complete online)
Securely submit your personal and medical information directly to our office. This will speed up your office visit and will help us to better serve your healthcare needs. Alternatively you may fill out your forms in the office by arriving 15 minutes before your scheduled appointment time.

Notice of Privacy Practices (read only)
Please carefully review this documentation.

Acknowledgement of Receipt of Privacy Practices (print and sign)
After reading the ‘Notice of Privacy Practices’ above, please bring this completed form with you to your first appointment with us.

Acknowledgement of Receipt of Privacy Practices
(print and sign)
After reading the ‘Notice of Privacy Practices’ above, please bring this completed form with you to your first appointment with us.

Additional Forms

Authorization for Release of Health Information (print, sign, fax or mail)
If you would like to have your records sent to our practice from another healthcare provider’s office, please send this form to your previous doctor/facility (not to Kaster Eye Clinic).

Authorization for Release of Health Information
(print, sign, fax or mail)
If you would like to have your records sent to our practice from another healthcare provider’s office, please send this form to your previous doctor/facility (not to Kaster Eye Clinic).