Forms & Insurance
The following forms are to be completed at check-in for new patients.
To expedite the check-in process, we suggest you download, print and complete the forms and bring them to your appointment
You can now fill out your new patient forms by going directly through the Online Patient Portal.
We require our patients to sign an Authorization to Release Information Form (Adobe Acrobat Reader required) to obtain a copy of any medical records from our practice. Any questions that are medically related will be referred to one of our technicians or physicians.
Please be sure to indicate how you would like to receive your records and allow up to 3 business days.
You can now obtain your medical records right away by going through the Online Patient Portal.
Insurance & Financing
Central Florida Retina gladly accepts patients with insurance coverage from all the companies below.
Our list grows and evolves daily to remain competitive with the ever-changing medical insurance market. Please feel free to ask if you don’t see a particular carrier listed: 800.255.7188.
We will be glad to investigate our participation with your tailored insurance company and are ready to discuss how we can help you obtain affordable care.
- AARP Medicare
- Advent Health Network (including Oscar and Bright)
- Aetna (PPO, HMO, Medicare and Better Health)
- BCBS (PPO, HMO, Medicare Advantage HMO and PPO, My BLue, Blue Select Federal, Advantage 65)
- Champus / Champ VA
- Cigna (Standard, Medicare)
- Division of Blind Services
- Envolve Vision (Sunshine, Ambetter)
- Evolutions HealthCare
- First Health
- Florida Healtcare Plans (limited to Triple Options and MPOS plans, Volusia & Flagler counties)
- GHI (Out of Network)
- Humana (Choice, PPO, Medicare PPO, Medicaid)
- Humana Gold Plus (Volusia and Flagler Counties only)
- Imagine HealthCare
- Medicaid: Standard, Share of Cost, Staywell, HealthEase, Prestige, Magellan
- Orange and Seminole County Medical Clinic
- Simply Medicaid
- Sunshine (Standard, Allwell, Ambetter)
- Tricare (Select, Prime, Tricare East, Standard)
- United Healthcare (Standard, Medicare Complete, Student Services, All Savers, Compass / Navigate HMO, Community, Dual Complete)
- Volusia Health Network
- Wellcare Medicare
- Wellcare Medicaid ( staywell, HealthEase, Magellan, Prestige)