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Referring Providers

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346-222-6626

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PATIENT FORMS

Please send all filled-out downloadable forms to our e-mail AREC@jaafarelannanmd.com or through fax

346-787-2267.

Notice of Privacy Practices

New Patient Registration Form

Financial Policy

Established Patient Update Form

Consents and Agreements

Consultation Request Form

Authorization for Release of Protected Health Information

About Us

Retina Eye Center

Patient Support

Educational Videos

Diseases

Macular

Macular Degeneration

Vitreomacular Traction

Macular Pucker/Epiretinal Membrane

Central Serous Retinopathy/ Chorioretinopathy

Central Serous Retinopathy/ Chorioretinopathy

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Idiopathic Parafoveal Telangiectasia/ Juxtafoveal Telangiectasia/

Idiopathic Parafoveal Telangiectasia/ Juxtafoveal Telangiectasia/

Cystoid Macular Edema (CME)

Peripheral

Floaters/Flashes

Posterious Viteous Detachment

Retinal Tear/Hole

Retinal Detachment

Lattice Degeneration

Infectious Retinitis

Endophthalmitis

White Dot Syndrome

Vascular

Diabetic Retinopathy

Retinal Vein Occlusion

Retinal Arterial Occlusion

Complications of Cataract Surgery

Retained Lens Fragment

Dislocated Intraocular Lens

Oncology

Choroidal Nevus

Congential Hyperrophy (CHRPE)

Trauma

Inherited Retinal Diseases

Inherited Retinal Diseases

Educational

Research & Education

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