Downloadable Forms

Patient Resources


Preparing for Your First Visit

We want your time with us to be special and enjoyable therefore we encourage you to download, complete and bring the following forms to your first visit so we can spend more time seeing you.

Medical History

In order for us to get to know you, please inform us of any current and past medical history that may or may not be pertinent to your visit so that we may personalize your visit and better serve your needs.


Download

New Patient Registration

All NEW and ANNUAL patients are recommended to fill out and bring this form to the office visit to expedite the registration process and get you seen by our doctors sooner.
English
Chinese
Spanish


Download

Patient Confidentiality

Your confidentiality is our prime concern.  Please let us know with whom we may contact, leave messages, or be at liberty to discuss your condition.


Download

Refraction Waiver

If you wear glasses or contact lenses or have vision less than 20/20, it is necessary to refract to determine your best vision with corrective lenses to determine the underlying causes of lowered vision.  With this form, please let us know if you accept or decline this service.


Download


 
Please find the Downloadable Forms in other languages below:

Medical History Form
Download Form in Chinese
Download Form in Spanish

New Patient Registration Form
Download Form in Chinese
Download Form in Spanish

Patient Confidentiality Form
Download Form in Chinese

Refraction Waiver Form
Download Form in Chinese

Pharmacy Information Form
Download Form in English
Download Form in Chinese

*Medical Records Request:
 You may print out the "Authorization for Release of Medical Records" form above and either mail, fax or email it to our Medical Records Department.

(Note: You will need Adobe Acrobat Reader software to open these forms.)

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