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If you are having a medical emergency, please call
9-1-1 or go directly to the Emergency Room.


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Jacksonville 800.237.3846
Daytona Beach 800.555.6590
Lake Mary 877.357.3846

Our regular office hours are:
Monday - Friday 8AM to 5PM.

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  1. For Patients / New Patient Forms

New Patient Registration Forms

Easy registration for faster processing at check-in
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New Patient Form Packets

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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.

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.

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