In addition to filling out this form, you can also contact us at our toll free number: (888) GA-RETINA or 888-427-3846.

IN AN EMERGENCY DIAL 911 OR YOUR LOCAL EMERGENCY ASSISTANCE NUMBER. THIS FORM IS NOT TO BE USED TO MAKE APPOINTMENTS OR SUBMIT PERSONALLY IDENTIFIABLE MEDICAL INQUIRIES.

For personally identifiable medical inquiries, please refer to our Patient Portal.

THIS FORM IS NOT TO BE USED TO MAKE APPOINTMENTS OR SUBMIT PERSONALLY IDENTIFIABLE MEDICAL INQUIRIES.

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