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.

Medical Records

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.

Our medical record procedures follow the guidelines prescribed by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The HIPAA privacy policy explains the disclosure of health information and patient rights. If you have any questions, please contact our office at 800.255.7188.

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
  • Aetna (PPO, HMO, Medicare and Better Health)
  • Allegiance
  • AvMEd
  • BCBS (PPO, HMO, Medicare Advantage HMO and PPO, My Blue, Blue Select Federal, Advantage 65)
  • Champus
  • Cigna
  • Coventry
  • Devoted
  • Division of Blind Services
  • Envolve Vision (Sunshine, Ambetter)
  • Evolutions HealthCare
  • First Health
  • Florida Healthcare Plans (Volusia & Flagler counties)
  • GEHA
  • GHI (Out of Network)
  • Humana (Choice, PPO, Medicare PPO, Medicaid)
  • Humana Gold Plus (Volusia and Flagler Counties only)
  • Imagine HealthCare
  • MailHandlers
  • Medicare: Managed Care Plans (Please call)
  • Medicaid: Standard, Share of Cost, Managed Care Plans (Please call)
  • Orange and Seminole County Medical Clinic
  • P.H.C.S
  • Sunshine (Standard, Allwell, Ambetter)
  • Tricare (Select, Prime, Tricare East, Standard)
  • UMR
  • United Healthcare (Standard, Medicare Complete, Student Services, All Savers, Dual Complete)
  • V.A. – Veterans Administration
  • Volusia Health Network
  • Wellcare Medicare
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