Patient Resources

Our Secure Patient Portal Log-in:
Patient Login


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

Please click on the image below to view our patient information book.
Black Hills Regional Eye Institute For Your Information

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

HIPAA Policy

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

Eye Institute Map


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.

Amsler Grid