Contact Us

Hours:
Mon-Tue, Thu 9am - 5pm
Wed 9am - 6pm
Fri 9am - 2pm

Phone:
(916)789-1959

Address:
1213 Pleasant Grove Blvd.
Roseville, CA 95678


Map It!


E-mail us


Notice of Privacy
Practices


Patient Forms

Below are two forms that are necessary for all new patients. Returning patients may sign and date the bottom of the prior year’s form and indicate any changes as necessary.

1. Download Patient Information Form: Click Here

2. Download Privacy Practices Form: Click Here

Below is a helpful questionnaire for patients suffering from chronic red, irritated eyes. This form will be valuable for your doctor in providing a detailed history of your symptoms.

Download Dry Eye Symptoms Checklist: Click Here

 

If you have trouble with the download link, try right clicking it and choose ‘save target as’.

These PDFs require a free plugin that may have come included with your browser. If you are having difficulties opening these files, Click Here to go to Adobe’s web site for Adobe’s PDF reader.

WordPress Appliance - Powered by TurnKey Linux