Patient Forms

Your First Visit

Visits to the retina specialist can be stressful. Our goal is to help you feel as comfortable as possible during your visit.
Here's what you can expect:


Please be sure to bring the following items to each appointment:
1) Photo ID (Driver’s License, Passport or other Government issued ID)
2) Insurance Cards
3) Your co-payment
There will be important paperwork to fill-out on your initial visit. This will provide us with pertinent medical and surgical history and medications which will help Dr. Khan make an accurate diagnosis and treatment plan.
Your efforts to expedite this process by printing and completing these forms prior to your appointment is appreciated. Patient forms will also be mailed to you.

Initial Evaluation & Diagnostic Testing

Discussion & Treatment


If you have any questions regarding your visit, please call us anytime at (260) 436-2181.

Retina Associates of Indiana

7621 W Jefferson Blvd
Fort Wayne, IN 46804
Hours: Monday - Friday
7:30 AM - 5:00 PM
We are dedicated to providing professional and compassionate care throughout your treatment.