--- title: Allied Eye | Patient Information description: Allied Eye | Patient Forms --- [![allied eye](https://www.alliedeye.com/hs-fs/hubfs/Alliedeye_April2019/Images/AlliedEyeLogo.png?width=723&height=298&name=AlliedEyeLogo.png "allied eye")](https://www.alliedeye.com/?hsLang=en) ## Patient Resources In order to decrease wait time in the office, please visit our patient portal or download new patient paperwork by clicking the link below.   [ New Patient Paperwork ](https://www.alliedeye.com/hubfs/NP%20Paperwork-1.doc?hsLang=en) [![Medical Records Release Form](https://no-cache.hubspot.com/cta/default/5641978/372f946f-8220-4fdb-894b-02bf49f84d9e.png)](https://cta-redirect.hubspot.com/cta/redirect/5641978/372f946f-8220-4fdb-894b-02bf49f84d9e) ##### Patient Forms Patients may request miscellaneous forms to be filled out by our physicians by leaving them with our receptionist. Please allow 24 hours for the forms to be completed.  - Misc forms - $50 ##### Patient Medical Records Requests - Most recent office visit is free of charge. - $25 fee for up to 1 year of medical records. - $50 fee for up to 3 years of medical records. - $15 fee for each additional year. ##### General Medical Records Request It is imperative that we make sure there is a waiver on file requesting those records. Nothing can be released, not even to the employer, without this form signed by the patient. - **Insurance** - $20 for the first 5 pages. - $0.50 for each additional page. - This fee should be charged to anyone requesting records other than a physician's office such as an attorney, disability departments, etc. - **Worker's Compensation** - $10 for the first 20 pages. - $0.25 for each additional page. ##### Our Cancellation and No Show Policy For the convenience of all of our valued patients and staff, we ask for a 48 hours' notice whenever you need to cancel an appointment. Getting cancellation information in advance allows us to adjust our staff schedule or notify another patient who might be waiting for an appointment opening. ---   ##### ![CareCredit_Image](https://www.alliedeye.com/hs-fs/hubfs/CareCredit_Image.jpg?width=419&name=CareCredit_Image.jpg) ##### [CareCredit - Apply for Allied Eye](https://www.carecredit.com/apply/confirm.html?encm=XD0GP1MxBmMBPQRgUWVdNAU_UTMEZwIwVDcAMlw4ATc&sitecode=B3CALAdToolkitANCardVision) CareCredit is different from a regular credit card. Use it to pay for out-of-pocket expenses not covered by medical insurance, and special financing options are available that you may not be able to get with other cards. Pay for health, and wellness care at over 225,000 enrolled providers across the nation. Once you've applied, you can use it again and again at any location that accepts CareCredit. Watch CareCredit's Informational video below:   ### PATIENT RESOURCES ### QUICK LINKS ### Contact Us Allied Eye 7405 Shallowford Rd. Suite 420 Chattanooga, TN 37421 MAIN: [(423) 855-8522](tel:4238558522) OPTICAL SHOP: [(423) 933-0010](tel:4239330010) FAX: [(423) 855-8533](tel:4238558533) [![allied eye](https://www.alliedeye.com/hubfs/Alliedeye_April2019/Images/MatzkinLogo.png)](https://www.alliedeye.com/?hsLang=en) Live Life With Better Vision - - - - - Allied Eye © 2019. [Privacy Policy](https://www.alliedeye.com/privacy?hsLang=en).