Patient Forms

PDF documents can be downloaded by clicking on the links below

For new patients, please download, complete and bring the following form to your appointment. If you wish to register patient information online, please contact the office with your email address. You will receive an email with instructions on how to set password for the patient portal. The email link will expire in 72 hours or you can use “Forgot Password” link on the login page.

Patient Registration Form

Đơn Kê Khai Lý Lịch Bệnh Nhân

Información Del Paciente Formulario


      1. Financial Policy

      2. Privacy Notice

      3. Medical Record Policy

      4. Medical Record Release to Alliance Retina

      5. Medical Record Release from Alliance Retina to Provider

      6. Patient Registration Form

      7. Directions and Maps

      8. Patient Portal User Guide