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Retina Center of New Jersey
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About Us
COVID-19 Update
History of Company
Locations
Bloomfield, NJ - Essex County
North Bergen, NJ - Hudson County
Ramsey, NJ - Bergen County
Teaneck, NJ - Bergen County
Union, NJ - Union County
Wayne, NJ - Passaic County
Map and Directions
Testimonials
Se Habla Espanol
Doctor Referral Form
Our Doctors
Patrick M. Higgins, M.D.
Lauren Angioletti, M.D.
Lee M. Angioletti, M.D.
Justin Gutman, M.D.
Louis V. Angioletti Jr., M.D.
Adnan Mallick, M.D.
Benjamin D. Freilich, M.D.
Cindy Calderón, M.D.
Ahmad Rehmani, D.O.
Diseases & Treatment
Patient Information
Appointment Information
What to Bring
What to Expect
Forms
Insurance / Billing
Financial Assistance Resources
Patient Education
Clinical Research
Research & Clinical Trials
Neovascular Age-Related Macular Degeneration (Wet AMD)
Non-Exudative Age-Related Macular Degeneration (Dry AMD)
Diabetic Macular Edema (DME)
Diabetic Retinopathy (DR)
Uveitis
Branch Retinal Vein Occlusion (BRVO)
Central Retinal Vein Occlusion (CRVO)
Vitreomacular Adhesion
Vitreous Hemorrhage
Retinal Detachment
Macular Telangiectasia
Stargardt Disease
Neurotrophic Keratopathy
Clinical Research Staff
Home
About Us
COVID-19 Update
History of Company
Locations
Bloomfield, NJ - Essex County
North Bergen, NJ - Hudson County
Ramsey, NJ - Bergen County
Teaneck, NJ - Bergen County
Union, NJ - Union County
Wayne, NJ - Passaic County
Map and Directions
Testimonials
Se Habla Espanol
Doctor Referral Form
Our Doctors
Patrick M. Higgins, M.D.
Lauren Angioletti, M.D.
Lee M. Angioletti, M.D.
Justin Gutman, M.D.
Louis V. Angioletti Jr., M.D.
Adnan Mallick, M.D.
Benjamin D. Freilich, M.D.
Cindy Calderón, M.D.
Ahmad Rehmani, D.O.
Diseases & Treatment
Patient Information
Appointment Information
What to Bring
What to Expect
Forms
Insurance / Billing
Financial Assistance Resources
Patient Education
Clinical Research
Research & Clinical Trials
Neovascular Age-Related Macular Degeneration (Wet AMD)
Non-Exudative Age-Related Macular Degeneration (Dry AMD)
Diabetic Macular Edema (DME)
Diabetic Retinopathy (DR)
Uveitis
Branch Retinal Vein Occlusion (BRVO)
Central Retinal Vein Occlusion (CRVO)
Vitreomacular Adhesion
Vitreous Hemorrhage
Retinal Detachment
Macular Telangiectasia
Stargardt Disease
Neurotrophic Keratopathy
Clinical Research Staff
What to Bring
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What to Bring
Appointment Information
What to Bring
What to Expect
Forms
Insurance / Billing
Financial Assistance Resources
Patient Education
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Insurance Referrals
: If a PCP (Primary Care Physician) referral is required for a Specialist visit based on your insurance carrier’s policy,
it is the patient’s responsibility to bring any required referral needed for the RCNJ exam
Referring Doctor Note
: Any documentation (note, drawing, etc.) provided by the referring physician, describing reason for the RCNJ visit
Photo Identification
: Ex. Driver’s License, Passport (if you do not have a Driver's License), etc.
All
Insurance cards
: Primary Insurance, Secondary Insurance (Medicare, etc.)
Specialist Co-Payment or Deductible
: Due at time of check in (if applicable, any outstanding balances owed for previous visits are also due at check in)
Medication
: a list of
all medication
and
eye drops
you are
currently taking
, including the name and dosage amount of the drug (Please bring the actual medication with you, if that is easier than creating a list)
Medical Records: (
only if needed, as per your referring physician
)
Copies of any medical records that may be important to share with the RCNJ physician
Completed New Patient Registration Packet
(all forms must be completed for new patients) Please use the following link:
Click Here for Patient Forms
New Patient Registration Form
HIPAA Notice of Privacy Practice Form
New Patient Medical History Form
Presione AQUI para el Paquete de Registro del Paciente Nuevo (Español)
(Español)