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    Request an Appointment

    Serving both Fort Myers and Naples residents, if you would like to request an appointment at one of our locations, please complete the form to the left and we will contact you soon.
    Note: We are not able to accept CONFIRMATIONS or CANCELLATIONS via the form. If you need to confirm or cancel your appointment with a Retina Health Center Serving both Fort Myers and Naples residents specialist, please call our office direct.

    Tips for Surgery

    With offices in Fort Myers and Naples, Florida, the Retina Health Center team is focused on the highest quality care available for our patients. We offer the most progressive treatment options available and are committed to keeping each patient safe and comfortable during their procedures.

    New Patient Packet

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    Record Release Form

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    Patient Medical History

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    Medications & Drug Allergies

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    Dilation Consent

    Click Here to Download

    Arbitration Agreement

    Click Here to Download

    Patient Acknowledgement Authorization 

    Click Here to Download

    Financial Agreement & Assignment of Benefits

    Click Here to Download

    Notice of Privacy Practices

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    Amsler Grid & Eye Chart 

    Click Here to Download

    Non-Discrimination 

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    Multi-Language Interpreter

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    Privacy Statement