Patient Forms
New Patient Paperwork
Every new patient of our practice is required to complete our New Patient Paperwork prior to an initial examination. You will be emailed a link a few days prior to your appointment to complete online. If you prefer, you may also print, complete, and bring a copy of the paperwork found below.
Medical Records Release or Request
To request a copy of your personal medical records or release your records from our office to another provider, you must sign and return an authorization form. Once completed, email the form to info@retinacolorado.com or fax to (303) 261-1601. Please allow 5-7 business days for our team to process.
Colorado Retina Policies
- Good Faith Estimate
- Good Faith Estimate (Spanish)
- HIPAA Policy
- Notice of Privacy Practices
- Notice of Privacy Practices (Spanish)
- Financial Policies
- Financial Policies (Spanish)
Co-pay Assistance Enrollment Forms
Financial assistance is available for certain intravitreal injection treatments, for eligible patients.
- EYLEA4U Patient Enrollment Form
- EYLEA4U Patient Enrollment Form (Spanish)
- Ozurdex Patient Enrollment Form
- Syfovre - Apellis Assist Enrollment Form | Apellis Assist
- Lucentis, Vabysmo, Susvimo (English)
- Lucentis, Vabysmo, Susvimo (Spanish)
