Eye Doctor Manchester NH | Medical Forms | Medical Eye Center
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The Medical Eye Center Logo
  • About
    • Patient Testimonials
    • Review Us Online
    • Careers
    • Symposium Presentations
  • Doctors
    • David A. Bellows, MD, FACS
    • Sara Bozorg, MD
    • Melissa Ernst Brenot, OD
    • Maxwell D. Elia, MD
    • Ahad A. Fazelat, MD, MPH
    • Jason A. Hall, MD
    • Amy L. Hennessy, MD, MPH
    • George J. Shaker, MD, FACS
    • Steven M. Siegal, OD
    • Dane H. Slentz, MD
    • Olga Stetsyuk, DO
  • Patient Info
    • Financing
    • Insurance
    • Forms
    • Your Appointment
  • Eye Conditions
    • Cornea Disease
    • Diabetic Eye Disease
    • Cataracts
    • Dry Eye
    • Macular Degeneration
    • Glaucoma
    • Eye Anatomy
    • Presbyopia
    • Astigmatism
    • Neuro-Ophthalmology
    • Retina Conditions
    • Uveitis
  • Services
    • Cataract Surgery
    • Glaucoma Treatment
    • Macular Degeneration Treatment
    • Diabetic Eye Disease Management
    • Dry Eye & Ocular Allergy Treatment
    • Eyelid Surgery
    • Cornea Surgery & Treatment
  • Patient Portal
  • Locations
    • Bedford
    • Hanover Street Manchester
    • River Road Manchester

Forms

IMPORTANT DOCUMENTS

  • Medical History Form
  • Notice of Privacy Practices
  • Non-Discrimination Notice
  • HIPAA Acknowledgment and Authorization
  • Financial Policy/Acknowledgement Form
  • Lifestyle Questionnaire (for cataract surgery consultations)
  • Request for Medical Records
  • Language Assistance Services

Patient Information

  • Financing
  • Insurance
  • Forms
  • Your Appointment
  • Notice of Privacy Practices
  • Non-Discrimination Notice

Click below to learn more about some of the common eye conditions treated at the Medical Eye Center.

cataracts Cornea Disease Glaucoma Macular Degeneration Diabetic Eye Disease Flashes & Floaters Dry Eye Syndrome neuro-ophthalmology

Manchester Location

250 River Road
Manchester, NH 03104

603-668-2020 603-668-0881 fax

Hanover Street Location

835 Hanover Street
Manchester NH, 03104

603-668-2020 603-668-0881 fax

Bedford Location

407 Riverway Place, Building 4
Bedford, NH 03110

603-668-2020 603-668-0881 fax
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note: The Medical Eye Center is a privately owned practice. For more information on the patient portal, please contact our office at 603-668-2020
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Non-Discrimination Notice | Notice of Privacy Practices