For Your Appointment

Our goal is to provide you, and your family, with superior eye care in an efficient and comfortable atmosphere. Our warm and caring personnel are dedicated to meeting your every eye care need.

Below you will find patient forms we need.  To save time please read, print and complete the necessary forms and bring them with you for your appointment.

 

Registration Form Instructions

Parents and guardians please complete the forms on your child's behalf if he or she is under age 18.

New patients, 19 and older please read and complete:
Adult (19 and over) : Forms 2 and 4.
Child (18 and under) : Forms 1, 4 and 6.

Form #1: Child Registration (18yrs and under)
Form #2: Adult Registration (19yrs and over)

Form #3: Authorization to Release Patient Information 

Form #4: Patient Medical History

Form #5: Financial Responsibility
Form #6: Notice of Privacy Practices
Form #7: Concent to Treat Minors
CEDFED

Need Help?

We are here for you, contact us for any questions you may have.

425-885-6600