Ophthalmology Flagstaff
Ophthalmologist Flagstaff | Dr Robert L Mahanti
Optometrist Flagstaff | Dr Brent Bullock
Near Vision CK | Laser Vision Correction | Implantable Contact Lens | Flagstaff
Contact Lenses Flagstaff
LASIK Surgery | Contact Lenses | Flagstaff
Patient Forms
The Eye and Laser Center: 900 North San Francisco St | Flagstaff, AZ 86001 | Tel: 928-779-0158
Patient Forms
Ophthalmology Consultation Flagstaff

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Patient Forms
 

The following forms can be downloaded to your computer and brought with you to your appointment. You may also fill them out online and submit them back to our office. In order for Dr. Mahanti to provide a complete and comprehensive medical opinion it is important that he reviews all your medical information. Please be prepared to provide this information to our office along with your current medical insurance information. Below are links to our patient information forms. If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit.

  Online Patient Forms
    Patient Information Packet *
* Best viewed in Internet Explorer 7 or higher

 

  Downloadable Patient Forms
    Patient Information Form   New Patient Health History      

    LASIK Surgery Instructions            


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If you do not have a copy of Acrobat Reader you can get one for free by clicking on the icon 'Get Acrobat® Reader'. This will take you to Adobe's website and enable you to download the Acrobat program to your computer.

 

 


 

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900 North San Francisco
Flagstaff, AZ 86001
928.779.7000
1.800.785.2590
401 S Calvary Way, Suite D
Cottonwood, AZ 86326
928.649.9000
     

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Procedures: CK | Laser Vision Correction | Cataract Surgery | Diabetic Eye Disease and Treatments | Glaucoma Treatments | Dry Eye Treatments
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Ophthalmologist Dr. Robert L. Mahanti and optometrist Dr. Punam Saini, serving Flagstaff and the surrounding area.

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