Download and Print Patient Forms

Our practice is a specialty eye practice limited to treatment of diseases and surgery of the retina and vitreous. Patients that are new to our practice will have a comprehensive consultation as well as possible additional testing ordered by the doctor.

The length of your appointment can vary based on the severity and complexity of your eye condition. As we are a referral practice, with frequent and unpredictable emergencies sent to us for our immediate attention, our appointment schedule at times may be delayed. The average appointment length is about two hours.

At your first visit, you will be asked to complete a registration form and a patient history form. To save time, you may download these forms and bring the completed forms with you to our office.

Medical Questionnaire Medical Questionnaire (107 KB)

Records Release Authorization Records Release Authorization (139 KB)

Assignment of Benefits and Financial Policy Agreement Assignment of Benefits and Financial Policy Agreement (206 KB)

Summary of Notice of Privacy Practices Summary of Notice of Privacy Practices (64 KB)

Acknowledgement of Receipt of Notice of Privacy Practices Acknowledgement of Receipt of Notice of Privacy Practices (48 KB)

Authorization for Release of Protected Health Information Authorization for Release of Protected Health Information (144 KB)

Mandell Retina Demographics Form Mandell Retina Demographics Form (119 KB)

Printable Directions to Virginia Beach Office Printable Directions to Virginia Beach Office (0 KB)


Please be prepared to bring the following with you to your appointment:

  • Current insurance cards/information
  • Current drivers license or identification
  • A list of current medications
  • Diabetic patients might want to consider bringing a snack
  • Insurance authorization/referral if your insurance requires this for specialist office visit
  • Copay/Deductible

Our Offices

Virginia Beach Office

397 Little Neck Rd
3300 South Building, Ste 202
Virginia Beach, VA 23452

(757) 227-4300
(757) 486-3125


Elizabeth City Office

Albemarle Eye Center
(Mandell Retina Elizabeth City, NC Office)

1503 North Road Street
Elizabeth City, NC 27909

(757) 227-4300
(757) 486-3125

Our Office

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