Forms

To better serve you, our patient forms are now available online. These forms can be printed and completed prior to your visit with Retina Care Center. Please bring the forms with you to your visit along with your current insurance card(s) and photo identification. 

  1. Medical History 

  2. Billing Authorization

  3. Acknowledge and Consent


HIPAA Law (Health Insurance Portability and Accountability Act of 1996) requires that we hand you a copy of our Notice of Privacy Practices. This document describes in detail how information about you, the patient, can be used within our office and with others who need to know for the reason of treatment, payment, and/or health care operations. If we were to disclose your information for any other reason, we would first need your written approval.