Dr. Randall Tozer - Scottsdale Ophthalmologist and Eye Surgeon



  • Patient Information Sheet
  • Release of Medical Records
  • Refraction Form
  • Privacy Notice
  • Acknowledgement of Privacy Notice

  • 9811 N 95th St, Suite 101
    Scottsdale, AZ 85258
    P: (480) 947-4493
    F: (480) 947-4751


    To shorten your time in the waiting room, Dr. Tozer has made several forms available online that you can fill out before your office visit.

    • Patient Information Sheet
      This form will help us collect all of your personal information and a brief medical history. This form is required for all new patients.
      Download Form (PDF)

    • Release of Medical Records
      This form will help us procure your medical records from your existing primary care physician. This form is required for all new patients.
      Download Form (PDF)

    • Refraction Form
      This form must be completed and signed if you are considering a refraction test for glasses and/or corrective lenses.
      Download Form (PDF)

    • Privacy Notice
      Please review our privacy notice carefully.  This form is for your records.
      Download Form (PDF)

    • Acknowledgement of Privacy Notice
      You must complete this form to indicate that you have read and understand the privacy notice.  This form is required for all new patients.
      Download Form (PDF)

    NOTE: Our forms are presented in PDF format. To view and print these files, you will need the Adobe Acrobat Reader. The Adobe Reader is free software that lets you view Adobe Portable Document Format (PDF) files.

    Download Adobe Reader

    Copyright © 2008 Randall K. Tozer, M.D., P.C. Web Design by Myriad Interactive