Physician Resources

Our goal at Southeastern Retina Specialists is to make your patient’s visit as pleasant and hassle-free as possible. We treat our patients like part of our own family, because their vision is our mission! Please print the forms below and ask the patient to complete and bring the forms to the appointment along with their insurance card and driver’s license. This will speed up the check-in process. Please also let the patient know that the visit will include having their eyes dilated, diagnostic testing and examination. Depending upon the complexity of the patient’s disease and treatments required, the entire process may take as much as 2-3 hours so please remind the patient to bring something to read and maybe even a snack.

Click the Form Below to Download:

• Patient Demographic Sheet
• Notice of Privacy Practices
• Privacy Practices – Signature
• Financial Policy
• Insurance Authorization Form
• Medical History
• Medication Listing
• Referral Pad – Jacksonville
• Referral Pad – St. Augustine
• Referral Pad – Palatka
• Referral Pad – Waycross