Welcome to Retina Consultants of Nevada

Thank you for choosing Retina Consultants of Nevada for your retina care! Please visit our welcome page to learn more about what to expect at your appointment, who we are and our appointment check-in process.

Patient Forms

You can print the complete forms package (14 pages) or each form individually.

Complete Forms Package

Patient Forms Package

Individual Forms

• Patient Referral Form
• New Patient Information
• New Patient Medical Information
• Medical Records Release
• HIPAA Notice of Privacy Practices
• HIPAA Notice to Patients
• HIPAA Appointment Designate

Amsler Grid Testing

Amsler Grid Testing is an at-home test to help detect changes in your vision, the Amsler Grid test can be an important indicator of diseases in the retina.

An at-home test to help detect changes in your vision

Instructions For Use

The Amsler Grid test can be an important indicator of diseases in the retina. Test your eyes daily to detect changes as early as possible. If you normally wear reading glasses, please wear them while performing this test. Proper lighting also is essential. The Amsler Grid should be held at normal reading distance and should be tested from the same distance each day.

1. Look at the dot in the center of the card. Cover one eye and continue to look at the dot for 10 seconds. Do not study it!
2. If you have retinal disease, the lines surrounding the red dot may not appear perfectly straight.
3. With a pen or pencil, note any irregularities on the card, such as increased distortion, blurring or blank spots. Indicate the approximate location of the irregularities on the grid.
4. Repeat the procedure on the other eye.
5. Notify Retina Consultants of Nevada if you see any sudden or significant changes in your vision.
6. Please down load the printable version to hang on your refrigerator.