Patient Forms

At Retina Associates of Western NY (RAWNY),We have provided a variety of forms that patients often find helpful.

In order to diagnose and treat you effectively, it is imperative that we gather all clinically relevant information. Therefore, we have provided access to the forms you will need to complete to assist us in this goal. Please bring these completed forms with you to your appointment.

Welcome Packet

Download & Print Form

Medical Records Release

Download & Print Form

Financial Policy

Download & Print Form

Kindly Print, Review and Complete forms.


Contact Us

We look forward to hearing from you.


Find us on the map

Photography for sliding banner by Joe Territo, Susan Warrington, and Margaret Whelehan