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.
- Aetna HMO (in Orlando only)
- Aetna PPO, Aetna US Healthcare Medicare Advantage, Aetna Medicaid (Orlando only)
- American Pioneer (as secondary to Medicare only)
- Amerigroup/Eyequest (as secondary to Medicare only)
- BCBS: PPO, Advantage 65, Traditional products, Federal, Blue Medicare PPO, Blue Options, Blue Choice, Blue Select, HMO, Health Options, Medicare Advantage HMO, “My Blue”
- Carefirst (BCBS)
- Cigna: PPO, EPO, HMO and Medicare
Access PPO (call for plan limitations)
- Coventry PPO
- Division of Blind Services
- Emblem Health
- Evolutions HealthCare
- First Health
- FL Healthcare Plans Triple Options Or POS
- Florida Hospital Physician Network – Allegiance (Disney Employees, Kumar Only)
- Florida Hospital Sunsaver & Explorer, FHHS employees
- GHI (claims will be considered out-of-network)
- Greatwest (Cigna)
- Humana: Choice Care, Commercial PPO, Premier HMO, Gold Plus (Volusia County only), Medicare Advantage PPO (Employer PPO, Employe Regional PPO, Choice PPO, Regional PPO, LPPO, MCare HMO), Humana Medicaid
- Imagine HealthCare
- MailHandlers (MultiPlan Network only)
- Medicaid: Standard Medicaid, Medicaid Share of Cost
- Envolve Vision: Coventry Health of Florida, Sunshine Health Plans, Ambetter, Allwell
- Orange County Medical Clinic
- PHCS – PPO
- Preferred Benefit Admin (PBA) (PPO only)
- Premier Eye Care: Healthease, Clear Health Alliance, Humana Medicare PPOs, Florida Healthcare Plus, Magellan, Prestige, Staywell, Wellcare Medicaid, Wellcare Mcare LPPO (Daytona and Palm Coast only)
- Principal Life
- Tricare East: Select, Prime, Humana Military
- United Health Care, UHC Medicare Complete (AARP), UHC Integrated Services, UHC Student Services, Compass HMO, Navigate HMO, UHC M+Plus (Medicaid), UHC Community Plan (some plans require PCP authorization)
- United American
- VA Choice, HealthNet (VA Referral)
- Volusia Health Network