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1-561-624-7878
About
About Our Practice
Clifford L. Salinger, MD
Ramsey Elhosn, MD
Services
Cataracts
Corneal Transplant
Dry Eye
Glaucoma
Keratoconus
LASIK Eye Surgery
Blepharoplasty
Cosmetic Injectables
Articles
For Patients
Patient Forms
The Eye Chart
Glossary of Terms
Surgery Center
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VIP Laser Eye Center Patient Forms
For your convenience, we have made several patient forms available to be downloaded and printed prior to your visit. Please complete these forms in advance.
New Patient
Paperwork
New Patient
Paperwork
En Español
Dry Eye
Questionnaire
Records
Release
To VIP
Records
Release
From VIP
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Ready to Learn More About Your Cataract Surgery Options?
First Name
*
Last Name
*
Phone Number
Email
*
Message
*
Preferred Method of Contact
Phone
Text
Email
Have you been diagnosed with cataracts?
Yes
No
I’m not sure
What would you like help with?
Cataract evaluation
Cataract surgery
Lens options
I’m not sure / I’d like more information
Preferred time to contact me
Morning
Afternoon
No preference
First Name
*
Last Name
Email
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Questions or Comments
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I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.
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