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Optical-longisland servicesdigital-retinalDigital Retinal Photography in FarmingdaleFarmingdale

Optical-longisland servicesdigital-retinalDigital Retinal Photography in FarmingdaleFarmingdale 2026

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The document outlines the EyeScreen Photographic Examination offered by Drs. Schmidt, Schauer, and Aberle, which is a high-resolution digital retinal exam designed to monitor and document retinal health over a patient's lifetime. It aims to detect potential ocular issues such as macular degeneration, glaucoma, and diabetic retinopathy, as well as signs of systemic health conditions. The procedure costs an additional $20 and includes an annual eye wellness photograph, detailed views of the retina, and a permanent medical record for future comparisons.

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Click ‘Get Form’ to open it in the editor.
Begin by reviewing the information about the EyeScreen procedure. This will help you understand its importance for your ocular health.
Locate the section where you need to select your preference regarding the EyeScreen photograph. Choose either 'I AGREE' or 'I DO NOT wish' based on your decision.
If you agree, ensure that you acknowledge the additional cost of $20 by checking the appropriate box.
Provide your signature in the designated area. If you are a minor, a parent or guardian must sign on your behalf.
Finally, enter the date of signing in the specified field to complete your form.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (37 Votes)
2016	4.5 Satisfied (47 Votes)

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