*All required fields must be completed. Please include non-medical questions and correspondence only. If you are having a medical emergency, please call 9-1-1 or go directly to the Emergency Room.To schedule an appointment, please contact our office at Jacksonville 800.237.3846, Daytona Beach 800.555.6590, Lake Mary 877.357.3846. Our regular office hours are 8AM to 5PM Monday through Friday.
*All required fields must be completed. Please include non-medical questions and correspondence only. If this is an emergency referral, please contact our office directly, Jacksonville 800.237.3846, Daytona Beach 800.555.6590, Lake Mary 877.357.3846. Our regular office hours are 8AM to 5PM Monday through Friday.
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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.
Click Here & Access Forms
Along with all forms included in your New Patient Packet, please also complete the following two forms and bring all forms with you.
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.
