For Patients

New Patient Registration Forms

In order to expedite the new patient registration process, we kindly ask you to print out all of the required new patient registration forms, complete and bring these forms with you to your first appointment.

• New Patient Registration Form


• New Patient Medical History Form


• Authorization for Insurance


• Patient Signature Form


• Medical Release Form

In addition to completing these forms, we ask that you please read the following document containing information on the Florida Retina Institute privacy practices. This document is for your personal information and you do not have to bring it to your appointment.

Florida Retina Institute - Privacy Policy

By providing us with the signed Patient Signature Form you acknowledge, with your signature, that you have read and fully understand the Florida Retina Institute privacy policies, as explained in the Privacy Policy document.