Digital Retinal Photography Our doctors highly recommend digital retinal imaging as part of your routine eye exam. This technology combines retinal photography with computerized imaging to allow instant viewing of the retina and optic nerve in great detail. Both the doctor and the patient will see the images on a computer monitor. This method of examining and documenting the retina promotes earlier diagnosis of abnormal conditions, which could allow us to prevent permanent vision loss. An additional benefit of retinal imaging is that we store the pictures permanently and compare them against any changes in the future. We are very excited about the results of this new technology and highly recommend retinal imaging as an additional optional test in your eye exam. The fee is only $39, but it is not covered by insurance plans. Please let us know your preference by checking one box below: Please perform Digital Retinal Imaging as recommended. I do not wish to have Digital Retinal Imaging performed. Patient Signature (Parent if child)*Patient’s Name* First Last Date* MM slash DD slash YYYY