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Go paperless with the Digital Retinal Imaging Acknowledgment form in your Eyefinity® Practice Management Online Scheduler. Customize your digital form and administration settings.
All fields are required unless noted.
Verify the questions you’d like to include in your Digital Retinal Imaging Acknowledgement form. You can use the suggested default questions or edit to customize.
Please see the example of what the form will look like when published to your website using the default text.
Please ensure your PDF size does not exceed 2MB.
Provide your email address to receive instructions on how to submit the PDF. Please only send forms by replying to the email with instructions and ensure your PDF size does not exceed 2MB. Any email sent with an attachment that exceeds the file size and has no-account info or case number will not be processed.
Customize administration settings to align with your practice workflow.
Select the form expiration time, which is the number of days before the patient is required to complete the form again. For example, if you want the patient to complete the form once a year, select 365 days.
Please complete this attestation before submitting the form.
