DISEASES AND SURGERY OF THE RETINA AND VITREOUS

713.524.3434 or 800.833.5921

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Forms

Please print out and complete the following forms before your office visit

  • Authorization for Release of Personal Health Information (PDF/52.28 KB)
  • Dilation Consent (PDF/7.5 KB)
  • Notice of Privacy Practices (PDF/49.61 KB)
  • Patient Information (PDF/40.95 KB)

TEXAS MEDICAL CENTER

  • 713-524-3434 OR 1-800-833-5921

THE WOODLANDS

  • 936-273-6620

MEMORIAL

  • 832-358-9306

NORTHWEST / CYPRESS

  • 281-970-9660

1960 AREA

  • 281-587-1987

SUGAR LAND

  • 281-494-5995

LIVINGSTON

  • 936-327-8733

BRENHAM

  • 979-836-2187
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