Patient Registration Form at Connecticut Retina Consultants
Contact us for more information. We have convenient locations to serve you in Hamden, Norwalk, Trumbull, New Haven, Madison, and Fairfield CT.
You can download a copy of the New Patient Form or fill it out digitally which includes a Welcome Message, Medical History Form, Patient Registration Form, office policies, and directions to our offices.
To Fill It Out Digitally Click Below
To Download, Complete and Print the Form at Home Click Below
On the day of your appointment, please bring the following with you:
- Your photo ID
- Current health insurance card(s)
- A completed Patient Registration form (enclosed)
- A completed Medical History form (enclosed)
- If you wear eyeglasses please bring them to your appointment
- A list of any medications, including dosage
- Your photo ID
- Current health insurance card(s)
- New Patient Packet
- Medical Records Release Form
- If you wear eyeglasses please bring them to your appointment
- A list of any medications, including dosage
Your eyes will be fully dilated to ensure a thorough retinal exam and may remain dilated for several hours afterward. For safety, we recommend that someone drive you home from each visit.