Chelsea Eye has made it possible for you to securely submit your patient form online!

By using this convenient and time-saving method, your information will already be entered into our system when you arrive for your appointment.

You can be assured that you will receive the best possible care at Chelsea Eye & Cosmetic Surgery Associates. 

If you have health insurance, any required co-payments and deductibles will be collected from you as indicated by your health plan.  Payment is requested at the time of your visit for any co-payments, deductibles or services not covered by your health care plan.  If your plan requires you to obtain a referral for every visit to a specialist, and you do not provide us with this form, we cannot bill your insurance company for our services, and you will be responsible for payment.  Payment can be made by cash, MasterCard, Visa, Discover or American Express.

Personal checks are not accepted.

For your convenience, the forms required for your visit to our practice are listed below.  Please click on the appropriate link, and you will be directed to a secure site to complete and submit the information.

NEW PATIENTS CLICK HERE (you will need a security code)

EXISTING PATIENTS CLICK HERE

TO HAVE SOMEONE CONTACT YOU CLICK HERE

We look forward to meeting you, and we thank you for choosing Chelsea Eye & Cosmetic Surgery Associates.  If you have any questions, please feel free to call us at 212.727.3717.

 

PRE-PROCEDURE INSTRUCTIONS CLICK HERE