How to Plan
One of the many things we do to try and make your first visit to RGW a smooth and pleasant experience is to provide you with the various medical forms to fill out in advance of your visit. There are four forms — Registration Form, Medical History Questionnaire, Dilatation Consent Form and Marketing Form — each of which is provided in PDF format at the bottom of this page. Please download the forms, fill in the necessary information, print out each completed form—and remember to bring them to your first visit to our practice.
Please bring any pertinent medical records from your referring provider and a list of all your medications and their dosages. Your identification and insurance cards are important for billing your insurance plan correctly, so please bring them with you. Arriving at least 15 minutes prior to your appointment will give us sufficient time to make sure your records have the important information we need.
Please allow three hours for your initial appointment as we have the ability to conduct many tests onsite. This will help us determine the health of your eye quickly. Since your eyes will be dilated during the initial examination, we also recommend you arrange to have someone drive you home if you are not using public transportation.
What to Expect
Due to the current COVID-19 pandemic, all patients and visitors must wear a protective face mask at all times and adhere to proper hand hygiene. When you arrive, you will be greeted by our medical receptionist, who will take your temperature. Anyone with a temperature above 100.4 will not be permitted to enter. Like all other RGW staff and physicians, the medical receptionist will be wearing appropriate Personal Protective Equipment (PPE). You will be asked to complete the patient registration form and medical history questionnaire. Information regarding dilating eye drops and an explanation of our Notice of Privacy Practices will be provided to you as well. All RGW clinics and office spaces have been redesigned to accommodate social distancing. If our patient-designated office areas become too crowded, visitors will be advised to wait in their cars until their appointment time. Only patients needing help with mobility should bring a companion to their visit.
Most of our patients are referred to us by other medical professionals, but we do accept all patients with retina problems. If you have been referred to us by a physician, please bring the Consultation Request Form since it provides a clear explanation of your eye problems as assessed by your referring physician.
Forms You Can Fill Out in Advance
New Patient Registration Form (English)
New Patient Registration Form (Spanish)
Returning Patient Form (English)