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New Patient Info and Forms

We're looking forward to seeing you at our clinic!

To help expedite the registration process:

1.  Download, print, and complete the forms below: 

If you don't have access to a printer, these forms will be available upon arrival at your initial visit with us. If you have any questions, call the clinic where you will be seen.

Beta testing the form on the right - please feel free to fill out the forms on the right; however, if you do not receive a call to schedule an appointment within 1-2 business days, please call any of our offices to schedule an appointment. 

Click here for our location address and phone numbers.

Keep these things in mind when completing your paperwork:

 

  • Complete the above forms in advance. This will expedite your registration and initial visit with us. 

  • Include an e-mail address if you have one.

  • Make note of the doctor(s) who referred you to us, and who you wish to receive a copy of your consultation report.

  • Bring your insurance information (and ID).

  • Have an accurate list of all of your current and previous medical problems and medications.

  • Any past medical history is useful (e.g. prior surgeries, allergies, family history of illnesses, etc.). 

Before your eye examination...

  1. It is important to understand that a complete retinal examination requires dilation of the pupils, preferably both eyes. We cannot do a thorough examination without dilation. Some people may have difficulty driving after dilation, and thus it is recommended that you have a driver if you feel it may be necessary. It can take several hours for dilation to completely wear off. Also, even if only one eye is affected with visual problems we can often gain valuable information by dilating and examining the other eye, so we suggest that you be prepared to have both eyes dilated.

  2. A complete examination consists of a vision and eye pressure test, dilation of the pupils, special photographic tests and a comprehensive examination by the physician. This does take some time and a new patient may be in the office for 1-2 hours, depending on the issue and level of urgency of the problem.

  3. We encourage patients that may have hearing or memory problems, or a language barrier, to bring a friend or relative with them.

  4. If you have specific questions you want answered, don’t hesitate to write them down and bring them with you.

What Are Your Symptoms

Click on the symptom below to find out more

If you experience any of these symptoms, call us at 

(951) 788-0222

to set up an appointment.

Common Diagnoses 

Some of the links will redirect you to the American Society of Retina Specialists website.

Patient Information

Please ensure all required fields are completed for accurate registration.

Preferred Office
Birthday
Sex

Insurance Information

If self pay, please disregard this section.

Your Treatment Options May Include:
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