“ Come see how affordable QUALITY eye care can be ! “   

NEW PATIENT REGISTRATION

We are excited you selected us to be your eye care provider. As a new patient, please bring any current glasses and insurance card(s) at the time of your visit. We ask that you arrive 15 minutes before your appointment To streamline your checking in, we have placed your registration forms on-line. One is a our HIPAA compliant consent form while the other is our history form. Please print, complete and bring them with you at your first visit with us.

Use your browsers back key to return to this page after you select and print your form.

New Patient History and Consent                                                   Infant History and Consent

In 1996 the US Congress passed legislation creating the Health Insurance Patient Portability Act (HIPAA) to protect the privacy rights of patient information. To view our privacy practices, please download a copy of our policy. 

Notice of Privacy Practice

If you do not have Adobe PDF on your computer, you can receive a free download at Adobe Reader      

       Dr. Joseph Audia  Rt. 1  Box 75-4   Salem, WV 26426  304-782-1005                         Dr. Joseph Audia   1403 East Pearl Street    Harrisville, WV 26362   304-643-2117

Send mail to draudia@wveyes.com with questions or comments about this web site.                    Copyright © 2010 Drs. Audia & Wickline             Last modified: 7/17/2010