Cataract Surgery in Fort Myers, Naples and South Florida

Schedule Appointment & Patient Registration Forms

Contact Us: 888-EYE-APPT

How can we help you?

Comprehensive Eye Exam:
1-888-EYE-APPT

Refractive Consultation or Exam: 1.866.393.2345

Setup Appointment with Optometrist:
1-888-EYE-APPT

Appointments for All Locations

Patient
Registration Forms

Please print and then fill out
the forms below and
bring them to the office.

Patient Registration Forms

The forms included in this registration packet enable us to learn about your health and how it affects your vision, understand your overall health, track the effectiveness of your treatment, and accurately bill your insurance.

We realize filling out paperwork for healthcare in today's world is time consuming. We have made every effort to minimize the paperwork required for our patients, while also getting the information we need to provide you with the highest quality service possible.

The following forms are included:

1) Patient Registration (click to download)
All new patients must complete this form. Existing patients may need to update information. Please bring your insurance card(s) to your first visit, as we will need photocopies for our records.

2) Patient Initial Questionnaire and Medical History (click to download)
Your answers on this form will allow us to have an accurate picture of your current physical condition and is valuable for a thorough evaluation by your doctor.

3) Patient Visual Function Form (click to download)
Completion of this form will give us a better understanding of your current visual acuity.

Adobe Acrobat Reader is required to view the forms above.
You can download a free version of Adobe's Acrobat Reader here.

More Information

Please contact the clinic where you have scheduled your appointment directly if you have questions. As a reminder, be sure to bring your insurance card and any co-payment that you may be required to make to the visit. We accept cash, personal checks, and bankcards and can arrange for financing.

Eye Centers of Florida

Call today for your Comprehensive Eye Exam:

1.800.226.3377 or 239.939.3456

Call or Visit Us at Any of Our 14 Locations:

Fort Myers Main Clinic 4101 Evans Avenue Fort Myers, FL 33901 (239) 939-3456 (800) 226-3377 Mapquest	Fort Myers East 4881 Palm Beach Blvd. Fort Myers, FL 33905 (239) 790-0127 Mapquest	Port Charlotte–Murdock Town Center Mall 1441 Tamiami Trail Port Charlotte, FL 33948 (941) 743-3125 Mapquest
Bonita Springs 26831 S. Tamiami Trail Bonita Springs, FL 34134 (239) 992-1422 Mapquest	Immokalee 555 N. 15th Street Immokalee, FL 34142 (239) 657-4486 Mapquest	Punta Gorda 3941 Tamiami Trail Punta Gorda, FL 33950 (941) 637-6100 Mapquest
Cape Coral 2301 Del Prado Blvd. Unit 650 Cape Coral, FL 33990 (239) 574-4443 Mapquest	Lehigh Acres 3507 Lee Blvd. Lehigh Acres, FL 33971 (239) 369-5884 Mapquest	South Ft. Myers The Aesthetic Center 5995 South Pointe Blvd. Fort Myers, Florida 33919 (239) 267-2288 Mapquest
Clewiston 820 W. Sugarland Hwy Clewiston, FL 33440 (863) 983-9105 Mapquest	Naples–Pine Ridge 2352 Pine Ridge Road Naples, FL 34109 (239) 263-2700 Mapquest	Venice 1435 E. Venice Avenue Venice, Florida 34292 (941) 485-4868 Mapquest
Fort Myers Beach 17105 San Carlos Blvd. Fort. Myers Beach, Florida 33931 (239) 454-6444 Mapquest	Naples North 877 111th Avenue Naples, Florida 34110 (239) 591-2949 Mapquest	The Audiology Center 4101 Evans Ave Fort Myers, FL 33901 (239) 939-5322 Mapquest