Patient Forms
If you would like to save some time when you check in for your first visit, please click to open and read the HIPAA Notice of Privacy Practices
HIPAA (English)
HIPAA (Spanish/Espanol)
Then please print these forms, fill them out, and bring them with you. Just click on the link below to download and print the forms:
New Patient Information Form
HIPAA Consent Form
Medication List
If you would like us to send your record to another doctor, please print, complete, and return this form:
Consent to Release Information Form
To view these forms, you will need to have a pdf viewer such as Adobe Acrobat Reader.
If you don't already have it, you can download it here:
A huge “Thank you” to Dr. Ghodsi and the staff at Delmarva Laser Eye Center! Each of you helped to make my recent Cataract Surgeries a pleasant and positive experience! I am SO thrilled to be able to see things in a “New Light”. Anyone contemplating eye surgery should know there is no better choice than Delmarva Laser Eye Center!
LeMoyne Meichner
2/2/2015
Dr. Ghodsi and her staff are the most thorough, competent and kindest group of professionals that I have ever experienced. Through the entire cataract surgery process I felt informed about my prognosis and comfortable before, during and after the surgery procedure. They certainly took away any fear or concern I may have had about having surgery.
Barbara Mulready
Dear Dr. Ghodsi: It is with great pleasure that I share my experience of cataract surgery with friends and prospective clients. From my initial appointment through the final procedure and follow-up visits, you and your entire staff made me feel confident as I faced the surgery. The level of professionalism was the best! As for the actual surgical procedure, I can’t find adequate words to express my appreciation. As a 70-something woman who began wearing glasses at age 6 and then progressed to contact lenses at age 14, I’m positively jubilant to have chosen the PanOptix lenses to correct my vision for distance, mid-range and close up. It’s been a miracle to wake in the morning, open my eyes and be able to view our beautiful world without fumbling around for my thick glasses or contact lenses. I will be forever grateful for your gift of sight! You are the absolute best in this field and I will continue to recommend you to all of my friends and acquaintances who are considering this type of eye surgery. With my sincere gratitude,
Debbie K