Patient Forms.

Patient Information File
File Size:	914 kb
File Type:	pdf

Download File

---

Please fill out the following patient information forms and bring them with you to your first visit. Signing "Acknowledgment of Receipt of Privacy Practices" on the form signifies that you have read the Privacy Policy, listed below.

• Patient Information Form
• Privacy Policy

[NOTE: This PDF requires a free plugin that may have come included with your browser. If you are having difficulties opening this file Click Here to go to Adobe's web site for Acrobat Reader.]

Our Optometry Clinic

​333 Main Street
Your City, CA  95512

​916-851-6556

Email Us

Hours:
Mon:  8am - 5pm
Tue:    8am - 5pm
Wed:  8am - 5pm
Thur:  8am - 5pm
Fri:      8am - 5pm
Sat:     8am - 5pm
Sun:    CLOSED