Patient Forms

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We are so glad that you chose Retina Consultants of Southwest Florida for your retina health needs. Below you will find forms and other information that you can download and print out.

For all patients, please make sure to bring the following with you to each visit:

New Patient Form

New Patient Forms

New Patient Forms

Medical Release Form

Medical Release Form

Medical Release Form

Injection Instructions

Injection Instructions

Eye injections are typically performed after the pupils are dilated. Anesthetic eye drops or gel and sometimes anesthetic injections are used to numb the eye to maximize comfort. A device designed to gently hold your eye open will be used to prevent blinking during the injection. Antiseptic is applied before the injection to reduce the chance of infection.

It is not unusual for your pupils to remain dilated for 24-36 hours after your visit.

Please follow these instructions after eye injections:

  • Do not rub your eye after treatment
  • If an eye patch was applied, you may remove it after 2-4 hours
  • For relief of mild to moderate pain or irritation, a non-aspirin pain reliever (eg: Tylenol) or cool compresses/ice packs can be used
  • Artificial tears/lubricating drops can be used

The following symptoms are normal after successful eye injections:

  • Blurry vision
  • Tearing
  • Mild floaters or bubbles in your vision for 2-3 days after treatment
  • Mild to moderate pain or irritation
  • Eyelash in the eye sensation
  • Redness, sometimes this can cover the entire white part of the eye
  • Bloody tears for 1-2 days after treatment
  • Runny nose
  • Sore throat

The following symptoms are not normal after eye injections, and you should call our office immediately if you experience:

  • Severe, constant pain
  • Severe, constant floaters
  • Curtain or veil in your vision
  • Cloudy vision
  • Significant decrease in vision

Please contact our office with any questions or concerns at (239) 939-4323 or (800) 282-8281.

Laser Instructions

Laser Instructions

Laser treatment is typically performed after the pupils are dilated, sometimes using a special lens. Anesthetic eye drops are used to numb the eye to allow placement of the lens on the front of the eye and to maximize comfort. If a lens is used, it is placed on the eye with lubricating ointment. The lens is removed after laser treatment. Some of the lubricant will remain on the surface of the eye, but most of it will be washed out after the treatment.

It is not unusual for your pupils to remain dilated for 24-36 hours after your visit.

Please follow these instructions after laser treatment:

  • Do not rub your eye after treatment
  • If an eye patch was applied, you may remove it after 2-4 hours
  • For relief of mild to moderate pain or irritation, a non-aspirin pain reliever (eg: Tylenol) or cool compresses/ice packs can be used
  • Artificial tears/lubricating drops

The following symptoms are normal after successful laser treatment:

  • Blurry vision
  • Sticky eyelids
  • Mild tearing
  • Mild to moderate pain or irritation
  • The same amount of floaters you had before, if applicable (laser treatment does not remove existing floaters)

The following symptoms are not normal after laser treatment, and you should call our office immediately if you experience:

  • Severe, constant pain
  • Severe, constant tearing
  • New floaters or a significant increase in the amount of floaters you had before treatment
  • Curtain
  • Cloud
  • Veil
  • Significant decrease in vision

Please contact our office with any questions or concerns at (239) 939-4323 or (800) 282-8281.

Surgery Instructions

Surgery Instructions

Prior to your scheduled surgery day, you will have a pre-operative appointment at Retina Consultants of Southwest Florida to sign surgical consents and to go over detailed instructions regarding your surgery. Please take this opportunity to ask our staff or your doctor any questions.

You will be given an envelope of completed paperwork to bring with you to the hospital or surgery center the day of your surgery. This envelope is required for the hospital or surgery center to have permission to prepare you for surgery. Without this envelope, your surgery will be delayed or cancelled.

Pre–Operative instructions:

  • Please refer to the specific instructions given to you during your pre-operative appointment.
  • Do not eat or drink anything after midnight the night prior to surgery.
  • On the day of your surgery please arrive at the hospital or surgery center as advised. You must be available the entire day of surgery. Cancellations and unforeseen delays may change your time of surgery.

The following symptoms are normal after surgery:

  • Blurry vision
  • Tearing
  • Mild floaters in your vision
  • Mild to moderate pain or irritation
  • Eyelash in the eye sensation
  • Swelling and tenderness around your eye
  • Redness, sometimes this can cover the entire white part of the eye
  • Bloody tears for 1-2 days after treatment
  • Light sensitivity/dilated pupil for several weeks
  • Runny nose
  • Sore throat
  • Droopy eye lid

Symptoms requiring immediate attention:

  • Severe, constant pain
  • Severe, constant floaters
  • Curtain or veil in your vision
  • Cloudy vision
  • Significant decrease in vision

On your first visit the day after surgery:

  • We will remove the eye patch
  • Your eye will be examined by your doctor
  • You will be given instruction for drops, positioning and activity restrictions
  • Your next office visit will be scheduled

Home care instructions:

  • Maintain positioning as directed by your doctor
  • Avoid aspirin, unless advised otherwise by your medical doctor
  • Take Tylenol, Advil or Motrin as needed for pain
  • Keep your hands clean
  • Gently clean your lids/lashes with a clean warm or cool cloth
  • You may shower but protect your eye from soap or any other irritants
  • Use eye drops as prescribed
  • Do not rub your eye
  • Avoid vigorous activity and heavy lifting
  • Use dark glasses as needed for comfort
  • You may wear your regular glasses
  • Reading will not harm your eye
  • If an air bubble was inserted during surgery, avoid high altitudes
  • Resume your regular medications
  • Resume your regular diet as tolerated
  • If you experience severe pain, vomiting and/or inability to take fluids and food please contact Retina Consultants immediately at (239) 939-4323 or (800) 282-8281.

Please contact our office with any questions or concerns at (239)939-4323 or (800)282-8281.

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Fort Myers

6901 International Center Boulevard
Fort Myers, FL 33912
(239) 939-4323(800) 282-8281
Fax: (239) 939-4712

Naples

2400 Goodlette Frank Rd
Naples, FL 34103-4596
(239) 263-3337(800) 282-8281
Fax: (239) 939-4712

Cape Coral

106 Del Prado Blvd S
Cape Coral, FL 33990
(239) 772-4323(800) 282-8281
Fax: (239) 939-4712

Port Charlotte

2525 Harbor Blvd Suite 302
Port Charlotte, FL 33952
(941) 627-4422(800) 282-8281
Fax: (239) 939-4712

Bonita Springs

3501 Health Center Blvd Suite 2170
Bonita Springs, FL 34135
(239) 939-4323(800) 282-8281
Fax: (239) 939-4712