Patient Forms

Personal Registration Form
File Size:	54 kb
File Type:	pdf

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medical_questionnaire.pdf
File Size:	25 kb
File Type:	pdf

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Optical Questionnaire
File Size:	64 kb
File Type:	pdf

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HIPAA Signature Page
File Size:	24 kb
File Type:	pdf

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HIPAA Privacy Policy
File Size:	40 kb
File Type:	pdf

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For Your Convenience,

You can print and complete these patient registration forms at home before your appointment. Please note that the HIPAA Privacy Policy is informational only. You do not need to include this document with your registration forms. If you prefer, you may fax the completed forms to our office at (805) 569-1155.

Please bring the following with you at the time of your appointment:

• Insurance Card(s)
• All Pairs of Glasses You Use
• Contact Lens Information (if you are a contact lens wearer)
• Medication Listing - Include Name, Strength, Dosage and Instructions of Use

Adobe Reader software is required to open these documents. If you don’t have it, please download it free at http://get.adobe.com/reader/