If this is your first appointment please complete the new patient packet for our records.

Please consider the following for your appointment:

  • Your appointment can last 2-4 hours depending upon specialized diagnostic testing and possible treatment.
  • Bring a snack or lunch, especially if you are diabetic.
  • Please bring a list of current medications, current providers, and available medical records.
  • Due to testing and possible treatment we recommend that a driver accompany you to your appointment.

Patients requesting their medical records or FMLA/Disability paperwork will need to complete the following forms:

Please note fees may apply and are listed on each form.

Service Animal Policy

FritzLiedtke-Retina NW-031

Diagnostic Testing

Persons visiting Retina Northwest solely for diagnostic testing should complete the following forms:
Patient Registration
Payment Policy
Privacy Practices Acknowledgment Form

Privacy Practices

It is Retina Northwest’s responsibility to protect your personal health information in accordance with applicable laws.  Please take a moment to download or print a copy of our privacy practices form for your records.  Copies are also available at all clinic locations.

In case of inclement weather, Retina Northwest will post clinic closure information under the Contact Us section.


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