Download Patient Forms

For our patient’s convenience, we have provided pdf downloads of all the forms we will need you to fill out when you visit us for the first time.

You may download and fill them out ahead of time, or, we will be happy to provide them on your arrival. Whichever you choose, we are always happy to assist you with completing them.

Patient Introduction Letter – Reno
This form tells you what to expect on your visit. It includes a list of the items you will need to bring. There is also a map page with the addresses and phone numbers for the Nevada Retina Associates Reno office.

Patient Introduction Letter – Carson City
This form tells you what to expect on your visit. It includes a list of the items you will need to bring. There is also a map page with the addresses and phone numbers for the Nevada Retina Associates Carson City office.

Patient Registration Form
This form includes all your primary information, such as your personal contact information, emergency contact, date of birth, referring physician, insurance, etc.

Medical History Form
This form covers your overall health as well as your eye history. It requires a list of past surgeries, family history of health or eye disease,tobacco and alcohol consumption, etc.

Patient Financial Policy Form
This form includes insurance information, referrals and pre-authorizations, self-pay patients, etc. It requires initials and a signature that you have read and understand it.

Notice of Privacy Practices
This notice describes how medical information about you may be used or disclosed and how you can get access to this information. 


 


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