Forms

For Patients

We would like to welcome you to the Michigan Retina Center! In order to expedite your initial visit with us, please print and complete the New Patient Forms by clicking on the button below.

When coming to your initial appointment, please bring the following:

  1. Completed New Patient Forms

  2. Identification (ID) Card

  3. Insurance Card

  4. Insurance Referral (if applicable)

  5. Medications List

Please arrive 10 minutes before your scheduled appointment and expect that the initial appointment may last up to 2 hours.  During the visit, your eyes will be dilated. As a result, you may prefer to have a driver take you to and from your appointment.

For Referring Physicians

We appreciate your referrals and are committed to serving your patients in the fastest way possible. To prepare a referral, please complete the referral form found below. To prepare a new patient to visit our office, please provide the new patient packet found below.  

To make a referral, please call (313) 441-2227.

To fax a document, please send to (313) 441-2241.

Dearborn

25230 Michigan Ave
Dearborn, MI 48124

Phone: (313) 441-2227
 
Fax: (313) 441-2241

Ann Arbor

 

Reichert Health Building
5333 McAuley Dr
Suite #1018
Ypsilanti, MI 48197

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