Long Beach Retina | Roberto Roizenblatt, MD, PhD, FASRS logo for print

3828 Schaufele Avenue, Suite 360
Long Beach, CA 90808
Phone: 562-444-8504
Fax: 562-363-0685

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Patient Forms

Patient Forms Packet

Please print and complete these forms before your appointment and fax them to our office or bring them with you to your appointment.

Individual Forms

If you need an individual form from the packet above, please choose form the list below.

Please print the following form for your records.