Patient Forms

Please browse through our patient information listed below - including patient registration forms, medical record release forms, insurance information, and CareCredit financing.

We participate with most insurance, please call 804.285.0680 to confirm participation with your plan.


Dominion Eye Associates and its affiliate offices participate with many insurance companies. Call your nearest Dominion Eye Associates today and confirm your coverage.



At all of our locations, we gladly accept Medicare and participate with most insurances. As a courtesy to our patients, we will file both your primary and secondary insurance forms.

Dominion Eye Associates accepts CareCredit for payment for services – for more information or to apply online, please visit

*CareCredit terms and conditions may apply.

For any and all billing, statement, or balance due inquiries only, please contact 877.969.0392.  All other clinical related questions should go directly through your physician’s office line.