Dr. Robert E. Benedett 
Diplomat, American Board of Ophthalmology
Member, American Society of Retina Specialists

The following forms are available in PDF format for you to print, fill out, and bring with you to your appointment.

New Patient Cover Letter

Forms Due upon Check-In:

Patient Information Form 2019 (Adult)

Patient Information Form (Child)

HIPAA Authorization to Release Information 2019

Other Forms:

Health and Medications Form

Medical Records Release From Ozark Retina & Macula

Medical Records Release To Ozark Retina & Macula

HIPAA Notice of Privacy Practices