Patient Information


Patient Forms

Medical History Form: Click here to download

HIPPA Contact Form: Click here to download

Release of Records

Should you require copies of your medical records, you will need to complete a records release form.

Please note the following in accordance with Florida Statute: For copies of chart pages, a minimum of 10 (ten) working days and not more than 30 (thirty) is required to process your request. These copies will be billed to you at a rate of $1.00 per page for the first 25 pages and $0.25 per page after that, payable prior to release of your copies.


We have financing available through CareCredit. Please click on this link, Care Credit, to be directed to their website. Please feel free to call our office if you have any questions.

Bentz Eye Center
4820 Okeechobee Blvd.
West Palm Beach, FL 33417
Phone: 561-898-2605
Fax: 561-689-5504
Office Hours

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