Patient Information Forms

Prior to your first office visit, please print and fill out all 3 forms in the links below and bring with you on the initial office visit. Also, please read the welcome letter located below the links.

♦ Click To View And Print Medical History Form

♦ Click To View And Print Patient Information Form

♦ Click To View And Print Refraction Form

 

Welcome to our practice. We are very pleased that you have selected us for your health care needs. We look forward to meeting you and providing you with personal and quality care. We pride ourselves on trying to make your medical eye care and treatment a pleasant experience.

Please fill out the enclosed forms and bring them with you to your visit. Please bring a list of all medications including the dosage or list them on the form where indicated. We will also need to copy your insurance cards and a photo I.D.

 

If you do not have insurance and are paying at the time of your visit or if you have a co-pay please be aware that we accept payment by cash or check but do not accept credit or debit cards.

 

If you have any questions, please do not hesitate to contact us at (727) 521-4669 so that we may assist you.

Sincerely,

Lawrence R. Goldberg, M.D. & Staff

Call and schedule an appointment today!

727-521-4669

VISIT US

4957 38th Ave N, Suite D

St. Petersburg, FL 33710

CALL

Tel: 727-521-4669

@2020 by Lawrence R. Goldberg, M.D., P.A.