New Patient Information

New Patient Information

Welcome to Retina Associates of Kentucky. We are pleased that you and your doctor have selected us to provide services to you. On this page you will find all the information you will need to plan your visit to our office. Below are listed some general guidelines about your visit and, several forms we would like filled out prior to your visit. 

Please call our office with any questions you may have. We appreciate your cooperation and, look forward to seeing you soon.

Planning your visit
Please have a driver come with you.
Be prepared to stay several hours.
You will need dark sunglasses when leaving the office (your eyes will be dilated).

Please fill out these forms prior to your visit and bring them with you:

  1. Patient Registration Form
  2. Privacy Consent
  3. Medical History Form
  4. Master Medicine List
  5. Notice of our Privacy Policy


These forms are pdf files. You will need Adobe Reader to open them.
If you do not have Adobe Reader please click the button below
to go to adobe.com to download it.


Click here to download Adobe Reader

 

 

Please bring with you:
A written list of all medications you are currently taking and the dose that you take.
A list of surgical procedures you have had, including the name of the physician(s) who performed those procedures.
Your insurance card(s).
Your photo ID.

 

 

We participate with the following insurance carriers:
AdminaStar of Kentucky Federal Medicare Carrier
Aetna US Healthcare
Anthem Blue Cross/Blue Shield
BCE Emergis
Bluegrass Family Health
CHA Provider Network, Inc.
C&O Employees' Hospital Association
Central Kentucky Physicians/Cooperative Care
CIGNA
CCN (part of First Health)
Coverage Options Associates
Cumberland Healthcare, Inc.
Department of Medicaid Services
First Health Network
FOCUS Healthcare Management, Inc.
Humana Health Care Plans
Humana Military Healthcare Services (CHAMPUS)
The Initial Group
MedBen
MultiPlan
Ohio Bureau of Workers' Compensation
Ohio Department of Health Services (Medicaid)
One Health Plan
Palmetto GBA (Railroad Medicare)
P.H.C.S. (Private Healthcare Systems)
SelectNet Plus
United Healthcare of Kentucky
USA Managed Care Organization
WVDHHR Medicaid (West Virginia)
West Virginia Workers' Compensation
And Others.

Please call us if you have a question about your insurance coverage before your visit.
Please come prepared to pay your co-pay or deductible insurance.
We accept Visa and Mastercard

Workers Compensation patients must bring:
The name of the employer at the time of injury.
The name of your Workers Comp insurance carrier.
Your Workers Comp claim number.
The date and time of injury.
A letter from your employer or Workers Comp insurance carrier verifying coverage for the injury or condition.