Eye Care & Surgeons of Charlotte
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Eye Care & Surgeons of Charlotte


Helpful Forms & Downloads

Please click on a form below to download.

New Patient Forms

(Please download and print 1-4. Fill out and bring to your appointment)

  1. Medical History Form
  2. Financial Policy Form
  3. HIPAA Consent Form
  4. Records Release Form

Additional Forms

Referral Form for Referring Providers


Click below to apply for CareCredit

Monroe (Main Location)

Eye Care & Surgeons of Charlotte, PLLC

602 S. Sutherland Ave
Monroe, NC 28112

Phone: 704-684-8400

Fax: 980-326-2079


South Charlotte / Ballantyne

Eye Care & Surgeons of Charlotte, PLLC

8924 Blakeney Professional Dr. (In Queen City ENT Building)
Charlotte, NC 28277

Phone: 704-684-8400

Fax: 980-326-2079


Monroe

Eye Care & Surgeons of Charlotte, PLLC

602 S. Sutherland Ave
Monroe, NC 28112

Phone: 704-684-8400

Fax: 980-326-2079


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