Before you come for your appointment, your doctor might ask you to fill out a form and bring it in with you. We’ve organized the forms by category to make it easier to find the one that you will need for your appointment. Click on a form to download it. Then fill it out and bring it in with you to your appointment.
All the information your provide will be kept confidential.
Binocular Vision Clinic Forms
- BV Welcome Letter
- BV History Form (Adult)
- BV History Form (Child)
- Policies for Visual Therapy and Visual Training Equipment
Medical Authorization Form
To receive medical records, patients need to fill out a records request form. You can either fax or email a copy of the completed form to our location. We can either fax or mail the records to you, but they can’t be emailed for privacy reasons.
Medical History Form
Myopia Control Clinic
- Myopia Informed Consent for Treatment
- Myopia Information and Policy
- Instructions for Orthokeratology Lens Wearers
Low Vision Clinic Form
If you are a primary care physician or other provider and are referring a patient to us, please fill out this form and fax or email it to us.
- Fax: (510) 642-8012
- Email: firstname.lastname@example.org
- Referral Form