Palmetto Ophthalmology Associates
Specialists in Eye Disease and Surgery

803-359-8777

340 West Butler Street
Lexington, SC 29072

  • HOME
  • OUR DOCTORS
    • DR. JENNIFER HARTEL MD
    • DR. SHAWN IVERSON DO
    • DR. LAUREN WILLIAMS MD
    • DR. S CLAY MILLER MD
    • DR. KUNAL D KANITKAR MD
    • DR. MARK S KEISLER MD
    • DR. SARA SHOCKNEY OD
    • DR. JOHN R WALTERS MD
  • LOCATIONS
    • PALMETTO OPHTHALMOLOGY ASSOCIATES 101 OAK PARK DRIVE
    • PALMETTO OPHTHALMOLOGY ASSOCIATES 340 WEST BUTLER STREET
    • PALMETTO OPHTHALMOLOGY ASSOCIATES 121 MAIN STREET
  • ABOUT US
    • ACCEPTED INSURANCES
  • OFFICE FORMS
    • OFFICE FORMS AND DOCUMENTS
    • MEDICAL RECORDS RELEASE FORMS
    • PATIENT PORTAL LOGIN
  • PATIENT EDUCATION
    • CATARACTS
    • CORNEAL DYSTROPHIES
    • DIABETIC RETINOPATHY
    • GLAUCOMA
    • CONJUNCTIVITIS
    • OPTICAL SHOP
    • PENETRATING KERATOPLASTY
    • PTERYGIUM
    • SURGICAL TREATMENT FOR GLAUCOMA
    • SUMMARY - OPHTHALMOLOGY
    • YAG LASER SURGERY
    • AGE-RELATED MACULAR DEGENERATION
    • COMPREHENSIVE EYE CARE
    • CORNEAL DISEASE
    • CORNEAL TRANSPLANT
    • DIABETIC EYE DISEASE
    • DRY EYE
    • EMERGENCY EYE CARE
    • ENDOTHELIAL KERATOPLASTY
    • INTRAOCULAR LENSES
    • ON-SITE OPTICAL SHOP
    • PRESCRIPTION EYEGLASSES
    • TREATMENT OF DRY EYE
    • SELECTIVE LASER TRABECULOPLASTY
    • PREMIUM LENS IMPLANTS
    • BOTOX® COSMETIC FOR MEDICAL USE
  • OPTICAL SHOP
  • JOIN

Office Forms And Documents

Patient Forms

The Palmetto Ophthalmology Associates provides our patients with office forms for your convenience. We recommend you print and fill these forms prior to your appointment to save time.

Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here.


Demographic Form


HIPAA Form


Patient Questionnaire


Notice of Privacy Practices

Patient Education

  • Age-Related Macular Degeneration
  • BOTOX® Cosmetic for Medical Use
  • Cataracts
  • Comprehensive Eye Care
  • Conjunctivitis
  • Corneal Disease
  • Corneal Dystrophies
  • Corneal Transplant
  • Diabetic Eye Disease
  • Diabetic Retinopathy
  • Dry Eye
  • Emergency Eye Care
  • Endothelial Keratoplasty
  • View All Topics

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Cataracts, Cataract surgery
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