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)
  • Clinical Trails (PDF/50.8 KB)
  • Dilation Consent (PDF/7.5 KB)
  • Notice of Privacy Practices (PDF/49.61 KB)
  • Patient Information (PDF/40.95 KB)

Texas Medical Center: Scurlock Tower

  • 713-524-3434

Bellaire: West Loop/Bellaire Blvd

  • 713-521-0555

Memorial: I-10/Gessner

  • 832-358-9306

Sugar Land: 59/Sweetwater

  • 281-494-5995

Katy: Cinco Ranch

  • 281-394-7959

Woodlands: 1-45/Hwy 242

  • 936-273-6620

North: FM 1960/Nanes

  • 281-587-1987

Northwest: 290/Huffmeister

  • 281-970-9660

Livingston

  • 936-327-8733

Brenham

  • 979-836-2187
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