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Patient Forms (Downloadable Version)

    New Patients: Please print and complete all of the forms under the "New Patient Form Package." You can bring your paperwork to your appointment or fax it to (770) 640-6789 - Attn: Front Desk.

  • New Patient Form Package (New Patients Only)

  • Screening Tests


  • New OptomapĀ® Retinal Exam: Dr. Zadeh recommends the optomapĀ® Retinal Exam as an integral part of your annual eye exam. An optomap provides a view of appropriately 82% of your retina in a single capture, assisting in the evaluation of your visual health.

  • Optomap Patient Education Form
  • Diagnostic Atlas Optomap
  • Comparison Fields Of View Patient

  • Established Patients: You can update your information at your appointment or use the same forms in our "New Patient Form Package" for any changes. You may bring your paperwork with you to your appointment or fax it to (770) 640-6789 - Attn: Front Desk.

  • Welcome back to our office form (Established Patients Only)


  • Requesting Records: If you need to request records for yourself or another doctor's office, please print and fill out the "Record Release Form" and fax to: (770) 640-6789 - Attn: Front Desk. Releasing records can take up to 2 business days for active patients and may take longer to retrieve old records. Thank you.

  • Patient Record Release Form


All insurance plans must be verified a day before your appointment. If we cannot verify your benefits prior to your appointment, you may have to pay out of pocket for professional services and self submit your examination for reimbursement.

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910 Holcomb Bridge Rd. Suite 100, Roswell, GA 30076
Phone: 770.992.6789  •  Fax: 770.640.6789


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