Patient Forms

Please browse through our patient information listed below - including patient registration forms, medical record release forms, insurance information, and CareCredit financing information.

We participate with most insurance plans, please call 919.736.3937 to confirm participation with your plan.



Dominion Eye Associates and its affiliate offices work with many insurance companies. Call your nearest Dominion Eye Associates today to determine the coverage of your insurance plan.


At all of our locations, we gladly accept Medicare and participate with most insurance plans. As a courtesy to our patients, we will file both your primary and secondary insurance forms.


Your best you is closer than you think! With Alphaeon Credit, you’ll find the widest array of monthly payment options to help your reach your individual wellness, beauty, and performance goals. Alphaeon Credit allows you to move forward today without delay. Plus, with special financing options not available with other credit cards, you may find Alphaeon Credit is the better way to pay. With Alphaeon Credit, you can receive the care your physician recommends with flexible payment options that fit your lifestyle. Apply today so you can focus on looking, feeling, and being your best.

Dominion Eye Associates also accepts CareCredit for payment for services – for more information or to apply on line, please visit

*CareCredit terms and conditions may apply.