Stephen E. Smith, MD - Specializing in Diseases of the Eye & Ophthalmic Surgery in Fort Myers and Naples, Southwest Florida

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		Fort Myers (239) 936-7685 Naples (239) 593-7747 Mon-Fri, 8am-5pm

For your convenience, our first visit forms are provided below. Please print and fill out these forms and bring them to your first visit.

New Patient Form

New Patient Health History Form

Privacy Practices Acknowledgement

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	Cataracts
	Glaucoma
	Blepharoplasty
	Diabetes
	Dry Eye
	Macular Degeneration
	LASIK


	Signs of Problems
	Amblyopia ('Lazy Eye')
	Conjunctivitis ('Pink Eye')
	Strabismus