All of our online forms are devised to give Dr. Deepak Raja a view of your medical history and help the ophthalmologist comprehend your questions, concerns and goals regarding your eye and vision health. This information is essential, as Dr. Raja uses it to better grasp your needs and provide quality care.
Here's how it works:
- Download the forms with AdobeReader® and then print them out. If you do not have AdobeReader, you can Download AdobeReader® for free.
- After you have downloaded and printed the forms, complete the required information.
- Fax your completed forms to our office or bring them with you to your appointment.
Help us expedite your office visit! Print and fill out your paperwork beforehand!
Please print the New Patient Form Packet and the Medical Release Form if you are coming from another eye clinic. The HIPAA form is there for your perusal at any time and does not need to be printed.
HIPAA Notice of Privacy Practice
Information for Surgery
Please choose and print the appropriate surgery center form:
Orlando Ophthalmology Surgery Center History and Physical Form
Orlando Health Systems History and Physical Form (Arnold Palmer, ACC, Dr. Phillips, ORMC)
Clinical handouts
If you have any questions, please do not hesitate to contact our office by calling (407) 704-3937.