Eyecare and Eyewear Redefined 408-612-4462

Patient Forms

Let’s make this simple

 Here you can download pertinent patient forms to fill out before arriving for your comprehensive eye and/or contact lens exam. Please DO NOT email sensitive health history or financial information as it is NOT secure.

1) Patient Registration Form
You must fill this out if you are a new patient, changing your name, address, contact information, or insurance information.
2) Health History Form
You must fill this out at every yearly visit. If there are no changes to your medical history, simply go to the bottom of the page where the checkbox indicates as such. You still need to fill out your name at the top and DOB.
3) Dilation Agreement/Deferral Form
You must fill this out at every visit.