Patient Portal and Forms

Welcome to our new patient portal –  myPatientVisit

To log in for the first time you will need the new security code that was provided to you at your last visit. Our practice ID is ESANE.

You can login by clicking here.

Previous Portal Users:  You will still need to signup for the myPatientVisit portal.   All of your medical information will transfer.

• Under “myDOCUMENTS” you can access your:

o Clinical Summary

 View, download, securely transmit, or email the summary of your visit, which will include your:

• Diagnosis (problem list)
• Medications
• Allergies
• Instructions (plan for care)
• Reason for visit

• Under “myMESSAGES” you can access:

o Secure Messaging

 Which will allow you to directly communicate with our doctors and staff and securely exchange information regarding your health care with our office.

Need help with the patient portal or have a question? Please CLICK HERE to view or download our FAQ sheet.

Patient Forms & Policies


If you want to print your forms and fill them out on paper, then click the links below:

* When signing the Patient Financial Acknowledgment form and providing your mobile phone number and email address, you are agreeing to be contacted by Eye Surgical Associates or on behalf of the Eye Surgical Associates.


Click the links below to download or print the Home Visual Acuity tests.


All forms are in PDF format. If you do not have a PDF reader, please click here for a free download.