Patient Forms

The following Patient Forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time, you will save a significant amount of time during your visit. Please be prepared to provide this information to our office along with your current medical insurance information. If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit.

NOTE:  The Retina Care Center is currently updating its practice management system and our electronic health record system. 

If your appointment is before June 7th please complete our current forms located HERE.

If you have an appointment scheduled on June 7th or beyond you will need to complete new patient registration forms, which can be found below.

 

FOR MARYLAND PATIENTS,
TO BE COMPLETED FOR APPOINTMENTS AFTER 6/7/2021

New Maryland Patient Registration Form

Returning Maryland Patient Registration Form

 

FOR NON-MARYLAND PATIENTS,
TO BE COMPLETED FOR APPOINTMENTS AFTER 6/7/2021

New Non-Maryland Patient Registration Form

Returning Non-Maryland Patient Registration Form

 

How we use and disclose your personal health information are detailed in the following forms:

Notice of Privacy Practices- Summary

Notice of Privacy Practices- Complete

 

If you need your medical records forwarded to a third party such a doctor’s office, please download the following form and send the completed form to our office via mail or fax.

Authorization for Medical Record Release