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If you are visiting our clinic for the first time, you could minimize your wait time by printing out the following forms, filling them out and bringing them with you. Also if you have had changes with your address, telephone number or insurance, just print out the Patient Information form, complete it and bring it with you to your next appointment.

Patient Registration Forms

pdf Receipt of Privacy Practice Form
pdf Patient Information Form
pdf Patient History Form

 

 

 

 

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  OKLAHOMA RETINA, PLLC
N.E. Srouji, M.D.

Diseases and Surgery of the Retina and Vitreous
3435 N.W. 56th Street Building A, Suite 808 Oklahoma City, OK 73112

Phone 405.945.4848  Toll Free 1.800.945.1290

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