For Patients

BFS Administrative Forms 

Please click the appropriate link below to download the necessary form. Most forms can be saved to your computer, completed on screen, and printed for signature and/or mailing purposes. However, you can also simply print them and fill them out by hand. You must have Adobe Acrobat installed on your computer to utilize the forms on this page.

Authorization for Release of Medical Records 

Authorization for Release of Medical Records - Partners

NOTE: A medical records release (authorization for release of medical records) must originate with the institution releasing patient information. This means that by completing this medical record release you authorize us to send information to an outside party. It does not however authorize an outside party to release of information TO Boston Foundation for Sight.

If you are a current or former BFS patient and would like to be seen at a BostonSight® PROSE partner clinic, please fill out the “Authorization for Release of Medical Records - Partners” form and mail or fax to the attention of the medical records department at Boston Foundation for Sight. (Please click here for mailing and fax information.)

Acknowledgement of Receipt of Privacy Notice 

Assignment of Benefits

BFS Notice of Privacy Practices

BFS Patient Waiver - General

BFS Registration Form - Please use this version for online completion ONLY.

BFS Registration Form - Please use this version to complete by hand.

Medical History Questionnaire

Medication List

Release and Authorization