Eye Doctor

(919) 438-3937 (EYES)
(919) 435-6785
Fax: 919-435-6792 | Map Us

Patient Forms

Download Patient Examination and Medical History Forms

Financial Policy

History and Review of Systems

New Patient Information Sheet

Notice of Privacy Practices

Patient HIPAA Form

Vision Insurance VS. Medical Insurance

Medical Record Access

HIPAA Privacy Authorization

Wellness Screening Consent

Credit Card Processing Fee Notice & Acknowledgment

310 S. Main St.
Rolesville, NC 27571

(919) 438-3937(EYES)
(919) 435-6785

Please be advised that Universal Eye Center charges a 3% processing fee on all creditcard transactions. To avoid this fee, patients may choose to pay by debit card, cash, or check, which do not incur an additional charge.
Credit Card Processing Fee Notice & Acknowledgment

Rolesville Office 310 S. Main St. Rolesville, NC 27571 Phone: (919) 438-3937 (EYES) Fax: (919) 435-6792

Universal Eye Center, P.A. proudly serves Rolesville, NC and the surrounding areas of Raleigh, Youngsville, Franklinton, Wake Forest, Louisburg, Millbrook, Knightdale, Wendell, Zebulon, Bunn and Cary.

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