If you have an appointment at Charles Retina Institute, and would like to register in advance, you can obtain registration materials in one of three ways:

Call us at:

(901) 767-4499 or (800) 423-0404

View and print the registration materials online:

Patient Registration Form

Health History

NOTE: The materials are in PDF format, which requires Adobe® Acrobat® Reader to view and print. If you do not already have it, you may download Adobe® Acrobat®.

Request the registration materials using our online registration materials request form.

NOTE: This is not the best method of requesting this material if you wish to keep the request or your mailing address confidential. E-mail over the Internet is inherently insecure!

When you have completed filling out the forms, mail them to:

Charles Retina Institute
6401 Poplar Avenue, Suite 190
Memphis, Tennessee 38119

Due to concern for your privacy, we cannot currently accept this information via E-mail.