New Patient
Registration Form

In respect to your privacy, we prefer to not have you submit forms via the internet. So we have provided the same paper forms you would fill out in our office, for you to print and bring with you.

Forms are in pdf format, and require Acrobat Reader or another pdf viewer.

Kansas Eye Surgery Associates, P.C.
Dr. Peter Kansas
24 Century Hill Drive - Suite #001, Latham, NY 12110
(518) 690-2015