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Name*
First Name Last Name
Age*
Phone*
Email*
Have you had an eye exam since the onset of your floaters?*
- Yes
- No
Do you have any flashes or black curtains in your vision?*
- Yes
- No
Any prior eye surgeries?*
- Yes
- No
How long have you had eye floaters?*
Any additional information you’d like to convey to Dr. Robin?
To submit the form, what does 4 + 3 =?*

DR. ROBIN ROSS

If you have more medical questions for Dr. Ross, you can email her directly here.

DR. ROBIN ROSS

If you have more medical questions for Dr. Ross, you can email her directly here.

Name*
First Name Last Name
Age*
Phone*
Email*
Have you had an eye exam since the onset of your floaters?*
- Yes
- No
Do you have any flashes or black curtains in your vision?*
- Yes
- No
Any prior eye surgeries?*
- Yes
- No
How long have you had eye floaters?*
Any additional information you’d like to convey to Dr. Robin?
To submit the form, what does 4 + 3 =?*

The Global Retina Institute

4835 East Cactus Road
Suite 105
Scottsdale, Arizona 85254
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Phone: (480) 534-8080 office

Fax: (480) 534-8081 fax

General Inquiries:
info@globalretinainstitute.com

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appointment@globalretinainstitute.com

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4835 East Cactus Road
Suite 105
Scottsdale, AZ 85254

Call: 480.534.8080

Email: info@globalretinainstitute.com

Fax: 480.534.8081

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Monday - Thursday: 8:00am - 5:00pm

Friday: 8:00am - 12:00pm

Friday: After 12pm-Emergency Only

Saturday - Sunday: Emergency Only

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