Prepare For Your Visit

Patient Forms

Save time in the waiting room by printing and filling out your paperwork before you arrive.

1. Download

Select the forms below

2. Print & Fill

Fill out by hand in pen

3. Bring to Office

Hand to our front desk

Note: These are strictly print-out forms and cannot be filled out online. If you do not have access to a printer, please arrive 15 minutes early to your appointment to complete them in our office.

New Patient Paperwork

Patient Intake Form

Required for all new patients. Includes your medical history, vision history, contact information, and insurance details.

Print Form

HIPAA Privacy Notice

Required for all patients. Details how your medical information may be used and disclosed, and how you can access this information.

Print Form

Treatment Consents & Waivers

Meibomian Gland Expression

Informed consent form required prior to receiving in-office gland expression therapy for dry eye management.

Print Form

Punctal Plug Consent

Informed consent form detailing the risks and benefits required prior to the insertion of punctal plugs for tear retention.

Print Form

Patient's Own Frame Waiver

Acknowledgment form required if you are providing an older, personal frame for us to insert new prescription lenses into.

Print Form

What Else to Bring to Your Appointment

Valid Photo ID
Medical & Vision Insurance Cards
Current Glasses & Contacts
List of Current Medications
TEXT FOR APPT
Los Angeles (310) 234-8900 Montrose (818) 330-7555