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New Patient Forms

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Please print out and complete the Patient Information forms below and bring them with you when you come in for your appointment.

Patient Information Packet
Patient Information Packet – Spanish

Privacy and Non-Discrimination

Notice of Privacy Practices
Non-Discrimination Statement

Should you need any other forms, please call us at 800-282-3937 for assistance.

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- The Refractive Surgery Council
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Our Locations

Auburndale

202 Magnolia Avenue
Auburndale, FL 33823

(863) 967-0668

Clermont

1050 US Highway 27
Suite 1 Clermont, FL 34714

(352) 394-8705

Haines City

100 Patterson Road
Haines City, FL 33844

(863) 422-4429

Lakeland - Harden

3350 Harden Blvd
Lakeland, FL 33803

(863) 662-3010

Lakeland - Highlands

2004 Co Rd 540A
Lakeland, FL 33813

(863) 937-4515

Lake Wales

2800 A Ridgeway Suite 100
Lake Wales, FL 33859

(863) 676-2008

Sebring

Surgery Center
5032 U.S. Highway 27 N
Sebring, FL 33870

(863) 382-3900

Winter Haven

Surgery Center
407 Ave K SE
Winter Haven, FL 33880

(863) 294-3504
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