NEW PATIENTS
Patient Forms and Resources
Patient Resources
Our staff looks forward to meeting you and discussing your goals. We strive to keep our appointments on time as scheduled. Prior to your appointment, we encourage you to fill out the patient forms that are located on this website so you can accelerate your check-in process. Please download, print, and complete the forms and bring them with you to your appointment. Additional paperwork will also need to be completed at the time of your visit regardless if you are a new patient or an establish patient. This can take an additional 15 minutes.
Notice of privacy practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. If you have any questions about this Novice please contact our Privacy Officer, Sherrie Kleekamp.
New Patient Information
Complete this form to provide Retina Associates of St. Louis with essential new patient information, emergency contacts, and medical history, ensuring comprehensive care for your eye health needs.
Patient Communications Consent
This form outlines the privacy policy and communication consent for Retina Associates of St. Louis, detailing the collection, use, and protection of your personal health information, and seeking your authorization for communication methods and information sharing.
Medical Insurance Information
Provide your medical insurance information to Retina Associates of St. Louis, including primary and secondary coverage details, and authorize insurance benefit payments for services received.
*Individual results are not guaranteed and may vary from person to person. Images may contain models.