Patient Forms

As part of our New Patient Center, we have compiled the forms you will need to fill out prior to your first visit with us. Unlike some offices that bombard you with paperwork as soon as you sign in, we give you access to forms so that you can fill them out at your own pace and in the comfort of your home or office.

We want your transition to our office to be smooth. Your time here should be spent relaxing and getting to know the staff that will be caring for you, not attending to questions and shuffling through papers.

All of our online forms are devised to give Dr. Deepak Raja a view of your medical history and help the ophthalmologist comprehend your questions, concerns and goals regarding your eye and vision health. This information is essential, as Dr. Raja uses it to better grasp your needs and provide quality care.

Here's how it works:

  • Download the forms with AdobeReader® and then print them out. If you do not have AdobeReader, you can Download AdobeReader® for free.
  • After you have downloaded and printed the forms, complete the required information.
  • Fax your completed forms to our office or bring them with you to your appointment.

Help us expedite your office visit! Print and fill out your paperwork beforehand!

Please print the New Patient Form Packet and the Medical Release Form if you are coming from another eye clinic. The HIPAA form is there for your perusal at any time and does not need to be printed.

New Patient Paperwork

Medical Release Form

HIPAA Authorization Form

HIPAA Notice of Privacy Practice

Information for Surgery

Please choose and print the appropriate surgery center form:

Orlando Ophthalmology Surgery Center History and Physical Form

Orlando Health Systems History and Physical Form (Arnold Palmer, ACC, Dr. Phillips, ORMC)

Clinical handouts

Amsler Grid

If you have any questions, please do not hesitate to contact our office by calling (407) 704-3937.

Contact Us

We look forward to hearing from you

Location

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Office Hours

Our Regular Schedule

Monday:

8:00 am-4:30 pm

Tuesday:

8:00 am-4:30 pm

Wednesday:

8:00 am-4:30 pm

Thursday:

8:00 am-4:30 pm

Friday:

8:00 am-4:30 pm

Saturday:

Closed

Sunday:

Closed