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AUTHORIZATION TO RELEASE INFORMATION

I HEREBY AUTHORIZE HIGHLAND OPHTHALMOLOGY ASSOCIATES, L.L.C. TO FURNISH THE INSURED’S INSURANCE COMPANY ALL INFORMATION WHICH SAID INSURANCE COMPANY MAY REQUEST CONCERNING MY CLAIMS.

ASSIGNMENT OF INSURANCE BENEFITS

I HEREBY AUTHORIZE ALL INSURANCE BENEFITS TO BE PAID TO SAID DR. OF HIGHLAND OPHTHALMOLOGY ASSOCIATES L.L.C. FOR SERVICES RENDERED. I UNDERSTAND THAT IF A SERVICE IS NOT COVERED BY MY INSURANCE THAT I AM FINANCIALLY RESPONSIBLE FOR SAID SERVICE. IF MY INSURANCE PLAN REQUIRES A REFERRAL AND I ARRIVE WITHOUT ONE, I UNDERSTAND THAT I AM FINANCIALLY RESPONSIBLE FOR PAYMENT FOR SERVICES.

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Highland Ophthalmology has been providing Specialty Eye Care Services including Cataract, Cornea and Glaucoma surgery in Orange County, NY and the Greater New Windsor area since 1997.
140 Executive Drive
New Windsor, NY 12553
(845) 562-0147

Office Hours

Monday: 8:30am–5:00pm

Tuesday: 8:30am–5:00pm

Wednesday: 8:30am–5:00pm

Thursday: 8:30am–7:00pm

Friday: 8:30am–5:00pm

Saturday: 9:00am–Noon

By Appt. Only