Vitreoretinal and Laser Surgery, Pharmacologic Retinal Treatment

The Visit

Dear Patient:

Drs. Maisel, Coe and Shah would like to take this opportunity to welcome you to the Retina Group of New York.  Please click on the name of the forms on the right, print them and complete them at home and bring them to the office.  It will save time if you bring this completed form when you come to our office for your visit.  You can expect to be in the office approximately 2 hours, depending on your eye problem, and the type of testing and treatment required. There is Handicap parking on the South side of the Hicksville building or the Northeast parking lot by the Chase bank in Hauppauge for your convenience.

You will need to come with a driver, since your eyes will be dilated for several hours.  Make sure you fill out both sides of the application, including the names and addresses of your primary care and referring doctors, and the amounts and types of medications you take.  Also, please remember to bring your glasses.

We participate in a number of insurance plans, including Medicare, but you will be responsible for any deductible or co-payment. We would be happy to assist you with any paperwork, if necessary.

IF YOUR INSURANCE COMPANY REQUIRES PRIOR APPROVAL OR A REFERRAL AUTHORIZATION, PLEASE BE SURE THAT WE RECEIVE IT BEFORE YOUR VISIT.

If you have any questions prior to your appointment, please do not hesitate to call us.

Sincerely,

James M. Maisel, M.D., FAAO  Rodney P. Coe, M.D., M.S.   Sabah A. Shah, M.D., M.B.A.

Forms to Print and Complete

Instructions: Please click below to download a form, then print and return by mail, fax to (516)-939-2510, or bring to our office.

Due to HIPAA regulations, these forms cannot be emailed to us or submitted online from the website.

 

Medical History

 

Patient Record Request

 

Consent to Obtain Patient Medication History

 

HIPAA Privacy Disclosure Authorization Form

 

Medicare Signature Form

 

Responsible Party Information

 

Languages Spoken (Please request translator when making appointment)

  • English
  • Spanish
  • Italian
  • Hindi
  • Urdu
  • Russian
  • Most other languages with translator

"The Retina Group of New York is used to handling urgent cases referred from other ophthalmologists such as trauma, complications of cataract surgery and retinal detachments.  We are delighted to provide second opinions in complicated cases.  We are available 7x24.  We frequently work with other retinal physicians in different parts of the country, especially with our snow bird patients ."