RESOURCES

PATIENT FORMS

NEW PATIENTS: WELCOME TO OUR PRACTICE!

Please click here to be taken to our eye health history form page!

Fill out the form as best to your ability and then click “Submit”. Once you click “Submit”, your information will come directly to us, so you don’t need to bring any paperwork into office unless otherwise asked for.

If your scheduled appointment is for a Vision Therapy Evaluation, please fill out the following form:
Additionally, please print out your completed form and bring them to your appointment or email them to us in advance! You can email it to [email protected]

If you are a TBI patient, please fill out the following form to help your doctor familiarize themself with your condition:
Additionally, please print out your completed form and bring them to your appointment or email them to us in advance! You can email it to [email protected]



RETURNING PATIENTS: WELCOME BACK!

We ask that you update your personal eye health history form prior to your appointment.
To do this, you will need to get a secure password to access your history. Please contact our office to obtain your personal secure passcode by calling us at 650-593-1661 or emailing us at [email protected]
Once you’ve acquired your password, please click here to be taken to our eye health history form portal , where you will update your history form.
WE OFFER:

Free Hands-On Workshops
Our office holds a free hands-on workshop to help educate our community about various topics such as vision and learning, vision and ADD/ADHD, Vision and Dyslexia, Sports Vision, Vision Rehabilitation and Corneal Refractive Therapy.
These workshops are designed to teach you about what vision skills can hinder reading and learning, sports performance, or rehabilitation. Learn what you can do if there is an underlying visual problem. Call to request a workshop or ask for a flyer about our upcoming workshops!

In-Service Talks
Similar to our Free Hands-On Workshops, we provide education to organizations such as PTA's, local schools and charities, occupational therapist groups, hospitals, etc. where it is most convenient for you - onsite! Give us a call to ask for details!

PROFESSIONAL REFERRAL FORMS

OD Fax Referral Form

CITT Symptom Survey

 BOOK AN APPOINTMENT
​         (Coming January 2020)