Referral Process/New Patients

Welcome to Retina Consultants, PLLC. Our practice is committed to innovation, excellence and providing you with the best eye care available. To expedite your first visit, please print and fill out the forms below before. If you have any questions, please do not hesitate to give us a call.

Patient Forms

• Authorization to Request Health Information

• Medicare & Insurance Authorization and Release of Information

• Notice of Privacy Practices Acknowledgement

• Notice of Privacy Practices

• Copays, Deductibles and Coinsurance Explained

• ACH Preauthorized Payments

Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader logo.