Set Up an Appointment

For Patients

To set up an appointment at Retina Specialists, please call (212) 604-9800
You may also request an appointment by filling out the form below.

For Referring Physicians

Thank you for referring a patient to Retina Specialists. To refer a patient, please call (212) 604-9800 or fill out the contact form below. To properly assist your patient and to provide the best care, please describe the reason for the referral and a summary of any diagnostic tests that have been performed.

For your convenience you will find our Physician Referral Page here.

You may also fax this information to us at (212) 242- 4757

Patient Information

Name *

Date of Birth *

Phone *

E-Mail *

Appointment Information


Preferred Doctor

New or Existing Patient

Date Preferred

Time Preferred

Physician Referral

If Yes, Please add Referring Physician information in Comments Section below.

Questions & Comments

* Required Fields