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 THIS PRACTICE HAS CLOSED PERMANENTLY.
PLEASE CLICK ON OFFICE CLOSURE LETTER FOR FURTHER INFORMATION.

LAKE SHORE RETINA, S.C.

OFFICE CLOSURE LETTER

USEFUL FORMS FOR PATIENTS


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PATIENT REGISTRATION FORM

Please download and complete this new patient registration form and bring with you to your first appointment along with a photo ID and insurance card.
patient registration form
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PAST MEDICAL & SOCIAL HISTORY FORM

Please download and complete this medical and social history form to the best of your knowledge and bring with you to your first appointment.
PAST MEDICAL AND SOCIAL HISTORY FORM
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HIPPA FORM

Please download and sign this privacy form and bring with you to first your appointment.
HIPAA privacy form

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