Salt Lake Retina

Patient Forms

Get all 3 Forms Combined

We have combined all the necessary forms you need into one single document.

Download Combined Forms

Prefill the forms to ensure a seamless check-in on your next visit to
Salt Lake Retina.

Need only a single form?
The individual forms are available below

Patient Information

Provides us with basic contact information, your insurance carrier, and an emergency contact.

Medical History

Helps your doctor understand the “whole picture” of your medical health and provide the best care possible.

HIPAA Consent

HIPAA consent explains our protection of your medical records and gives us consent to care for you.

Contact Us