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ACKNOWLEDGEMENT OF NOTICE OF PRIVACY PRACTICES

  • I HAVE READ AND UNDERSTAND THIS FORM. I AM SIGNING IT VOLUNTARILY.

  • Date Format: MM slash DD slash YYYY
  • If you are signing as a personal representative of the patient, please indicate your relationship


A Message to Our Patients

Our patients’ eye care needs are and always have been our top priority. With all that is happening, we are OPEN to help serve our patients. During this difficult time, we have made a few adjustments to our services and availability to ensure the health and safety of you, our staff and our Doctors.

For the Protection of Our Patients,
we have implemented the following procedures in our clinic:

Thank you for your support and understanding during these unprecedented times.

We hope to be able to continue to provide excellent care and service.

God Bless,

Robert M. Barton, Jr. O.D. and Staff