You may print and fill out any of these forms to help speed up your check-in time at your next appointment. Fax 605-341-0278
Patient Information Form
Medical History Form
Release Of Information Form – Medical Records
If you would like a copy of your records or need a copy sent to a doctor’s office, please fill out this form and return to the Eye Institute.
Financial Policy for Patients
Please take a moment to review our Financial Policy. If you have any questions please call 605-341-2000 Download
This form outlines the HIPAA Policy at Black Hills Regional Eye Institute.
Notice of Medical Information Privacy Rights
Patients Bill Of Rights
Rapid City Hotel Listing
Eye Institute Map – Rapid City Location
Scleral Lens Insertion Video
Amsler Grid – Vision Test
- Test Each Eye Separately – Cover the eye that you are not using.
- Keep the grid at a normal reading distance from your face.
- Look directly at the dot in the center of the grid.
- If you normally wear glasses, do so while looking at the grid.
- If you notice blurry or wavy lines, and dark or blank spots, call your Retina Specialist Immediately.