Your Visit to Our Offices
If you have any questions when you are filling out the forms, our office staff would be happy to assist.Simply call us at (800) 273-3005
At Retinal Eye Care Associates, we strive to provide the best eye care available anywhere in the county.
To help make your visit with us easier, we have provided these forms for you to complete. In order to expedite the new patient registration process, we kindly ask you to (1) open, (2) print, (3) complete each form and bring them all with you to your first appointment.
- Patient Information Form
English | Spanish - Medical History Questionnaire
English - Notice of Privacy Practices
English | Spanish - Consent for Dilation
English | Spanish - Consent to Discuss Healthcare
English - Acknowledgement of Privacy Practices
- Insurance Card
- Driver’s License or Photo Identification Card
Payment Information
We accept the following forms of payment: VISA, MasterCard, Check or Cash. In addition, payment plans and financing options are now available to you through CareCredit Healthcare.
These forms are in Adobe PDF format and will open in a new window.
If you need the free Adobe Reader, please click here.
If you need the free Adobe Reader, please click here.