314.367.1181
800.888.0011
New Patients
Thank you for choosing The Retina Institute for your eye care needs.

For your convenience, you can access and download some of the paperwork necessary for your appointment.  Prior to seeing your physician, you will be required to complete the following forms:


Patient Registration Form

Medical History Form

Authorization of Communication to Designee

Payment Policy & Authorization of Benefits



Upon your arrival at our office, you will also be offered a copy of our Notice of Privacy Practices.  We are required by law to inform you how your health information may be used and disclosed.  If you wish, you can review this policy now by clicking the highlighted link.

Acknowledgement of Privacy Practices Received


Once again, we thank you for choosing The Retina Institute.
 
 
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