• Home
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Roki Logo
  • Home
  • Our Practice
  • Dr. Neel
  • Dr. Idrizovic
  • Patient Forms
  • Contact / Directions
  • Clinical Trials
  • Patient Portal

Patient Forms

  • Home
  • Our Practice
  • Dr. Neel
  • Dr. Idrizovic
  • Patient Forms
  • Contact / Directions
  • Clinical Trials
  • Patient Portal

Click any of the links below to download forms:

pdf

Patient Information

Demographics Information

Medical History Questionnaire

Patient Financial Agreement

PHI Consent

HIPAA Consent

Release of Medical Information

Questions?

Contact Us!

GLAUCOMA CENTER OF TEXAS
9600 N. Central Expressway, Suite 300
Dallas, TX 75231

phone: 214-739-3900
fax: 214-739-3901
medical records fax: 972-499-1206

Our New Location!

GLAUCOMA CENTER OF TEXAS
2380 S. Goliad St., Ste. 130
Rockwall, TX. 75032

phone: 214-739-3900
fax: 972-722-4327
medical records fax: 972-499-1206

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