Patient Registration Form

Online Patient Registration Form

There are several steps to successfully completing this form. For the best experience, please fill out the form using Google Chrome.

  1. Before you begin completing this form, please scroll to the bottom of the page and click the blue continue button. This will make the form turn from gray to white and the highlighted fields will then be clickable.
  2. Once the mandatory red asterisk fields are complete, a blue click to sign box will appear.
  3. After you click the blue box, you will be prompted to enter your email address.
  4. Please check your inbox for an email from Adobe Sign and click confirm my email address.
  5. Your new patient paperwork is now complete and has been securely submitted directly to our office.
  6. Once the welcome desk team reviews your paperwork, a copy will be emailed to you from Austin Retina.

If you have any issues with the steps listed, please contact our office at (512) 451-0103, option 1, and a team member will gladly assist you.