For Our Patients

New Patient Registration Form

Easy registration for faster processing at check-in

image of jonathan staman md at check in with an employee

New Patient Form Packets

Along with all forms included in your New Patient Packet, please also complete the following two forms and bring all forms with you.

Medical Release Form HIPAA Signature Form

By providing us with the signed HIPAA 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 HIPAA Privacy Policy document.

Adobe PDF reader should be installed on your device. To download or fill and sign the forms, please click on the following helpful links, where you can learn more about how to easily fill out PDF forms, bring the forms with you and sign them during check-in for your appointment. Please do not sign the forms prior to your appointment.

About Adobe Acrobat How to Fill & Sign Form

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