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.
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
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