Patient Forms

New & Existing Patients

If you are a new patient, or are an existing patient that has some changes in their medical history, you will want to download the medical history questionnaire. Filling out the form and bringing it with you to the office may expedite your visit.


Most all medical and vision insurance plans accepted including:
  • NVA, Optum/Spectera, Safeguard, Local 770 Union, Avesis, Aetna, Blue Cross, Blue Shield, CIGNA, Davis, Delta-PMI, EyeMed, GoldenWest,
  • As well as:
  • Health Care Partners, Locals, Medicaid, Medical Eye Services, Medicare, MetLife, PacifCare, Vision Plan of America and Vision Service Plan
Call our friendly staff and we will be happy to verify your insurance.

Our Location


7 W Foothill Blvd, Arcadia, CA 91006
Located in the Arcadia Laser Eye Institute Building

Tel: 626-795-3453
Fax: 626-795-0047

Mon-Fri: 9:00am-6:00pm
Saturday: appointment only