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Providers
Dr. Thomas Shane
Dr. Anita Shane
Dr. Konica Singla
Dr. Maria Castaños
Gabriel Dib, FNP-C
Ayah Etyem, PA-C
Kayla Fischer, PA-C
Services & Education
Dilated Retinal Exam
Diabetic Retinopathy
Dislocated Intraocular Lens
Eye Floaters & Flashes
Macular Degeneration
Macular Edema
Macular Hole
Macular Pucker
Retinal Artery Occlusion
Retinal Detachment
Retinal Vein Occlusion
Treatments
Macular Degeneration Treatment
Syfovre & Izervay Dry AMD Treatments
Valeda Dry AMD Treatment
Intravitreal Eye Injection
Floater & Flashes Treatment
Retinal Tear Treatment
Diabetic Retinopathy Treatment
Susvimo Ocular Implant
Macular Pucker Treatment
Macular Edema Treatment
Macular Hole Treatments
Retinal Artery Occlusion Treatment
FAQs
Forms
Locations
South Tamiami / Bee Ridge Office
North Sarasota / University Parkway Office
Venice Retina
Contact Us
Consultation Request Form
If you are a physician and would like to refer a patient to Shane Retina, please fill out and submit this form.
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Company
This field is for validation purposes and should be left unchanged.
Patient Name
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Patient Date Of Birth
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Patient Phone#
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Email
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*Email where you want the confirmation sent
Requesting Physician
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Reason for Consultation
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Drawings
Please include any drawings of the eye that describe the condition to your patient. Not required but helpful.
Your Name
Your Name
Your Name
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Who is making the appointment?
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Our office has made the appointment with Shane Retina
Patient will call Shane Retina to schedule appointment.
Shane Retina will call patient to schedule appointment.
Time of Appointment:
Date of Appointment:
Appointment Location
2401 University Parkway, Suite 205, Sarasota, Florida 34243
3906 South Tamiami Trail, Sarasota, Florida 34231
