Primary Location

(601) 483-2616

Secondary Office


Online Forms

PatientDemographics.pdfAs part of our New Patient Center, we have compiled the forms you will need to fill out prior to your first visit with us. Unlike some offices that bombard you with paperwork as soon as you sign in, we give you access to forms so that you can fill them out at your own pace and in the comfort of your home or office.

We want your transition to our office to be smooth. Your time here should be spent relaxing and getting to know the staff that will be caring for you, not attending to questions and shuffling through papers.

All of our online forms are devised to give Dr. Goodman and Dr. Moore a view of your medical history and help the ophthalmologist comprehend your questions, concerns and goals regarding your eye and vision health. This information is essential, as Dr. Goodman and Dr. Moore uses it to better grasp your needs and provide quality care.

Here's how it works:

  • Download the forms with AdobeReaderĀ® and then print them out. If you do not have AdobeReader, you can Download AdobeReaderĀ® for free.
  • After you have downloaded and printed the forms, complete the required information.
  • Fax your completed forms to our office or bring them with you to your appointment.

Download and print your New Patient Registration form here

Download and print your Patient Demographics form here

If you have any questions, please do not hesitate to contact our office by calling (601) 483-2616.


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