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Forms

NEW PATIENTS: Please print and fill out the Welcome Form and Medical/Vision History Forms on this page to expedite your exam.

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Please sign and date forms and remember to bring them with you to your appointment.

 

 

 

 

 

 

 

Please review our office's Privacy Practices, which is in compliance with HIPAA (Health Insurance Portability and Accountability Act) and sign and date the consent form to bring with you to your appointment.
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HIPAA

We look forward to seeing you in our office soon!

Eyewear Gallery

Make an Appointment

2366 El Camino Real, Suite 5 Santa Clara, CA 95050
 

Tel: 408-246-5858

Fax: 408-246-5717

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info@eyetopiaoptometry.com

Hours of operation

Monday - Friday: 9:00am to 6:00pm

Saturday: 9:00am to 3:00pm

Sunday: Closed

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Copyright 2022 Eyetopia Optometry, All Rights Reserved.

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