Appointment Checklist

Please Remember to...

  • Bring your insurance cards.
  • Bring your co-pay if one is required by your insurance.
  • Obtain a referral from your primary care physician if required by your insurance.

First Appointment?

Please download, print, and fill out these forms to bring with you to your first appointment with us.

Demographics Demographics (199 KB)

Medical History Form Medical History Form (196 KB)

Notice of Privacy Practices Notice of Privacy Practices (146 KB)

Authorization for Release of Information Authorization for Release of Information (32 KB)

Consent to Treat Consent to Treat (195 KB)

Acknowledgement of Receipt of Notice of Privacy Practices Acknowledgement of Receipt of Notice of Privacy Practices (188 KB)

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Offices

Our Physicians

Take a few moments to meet the skilled physicians of Palmetto Retina, P.A.

Please Contact Us For More Information

(803) 931-0077 | (888) 931-0077