PATIENT FORMS

All of our online forms are devised to give Dr. Deepak Raja a view of your medical history and help the ophthalmologist comprehend your questions, concerns and goals regarding your eye and vision health. This information is essential, as Dr. Raja uses it to better grasp your needs and provide quality care.

Here's how it works:

Download the forms with AdobeReader® and then print them out. If you do not have AdobeReader, you can Download AdobeReader® for free.
After you have downloaded and printed the forms, complete the required information.
Fax your completed forms to our office or bring them with you to your appointment.

Learn More Make an appointment

Help us expedite your office visit! Print and fill out your paperwork beforehand!

Please click on the patient portal and complete your registration in advance of your visit. For assistance, please call 407-674-1856 or email welcome@remagin.com.

Patient Portal

INFORMATION FOR SURGERY

Please choose and print the appropriate surgery center form:

Orlando Ophthalmology Surgery Center History and Physical Form

Orlando Health Systems History and Physical Form (Arnold Palmer, ACC, Dr. Phillips, ORMC)

CLINICAL HANDOUTS

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If you have any questions, please do not hesitate to contact our office by calling (407) 705-2115.

What Our Clients are Saying

"My husband had surgery to lift his brow, upper eyelids, and lower eyelids. The results were superb and the difference is so dramatic."

Patricia

"The office staff is very friendly and courteous. I have always been able to get an appointment promptly. I highly recommend Remagin."

Laura

"Excellent customer service, no long waiting, and annual eye complete within an hour. I definitely recommend the Remagin for your eye care. See you next year. Thank you!!"

Melody

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