Forms

Thank you for taking the time to complete our forms.  At Pacific Eye Associates, we encourage our patients to fill out the registration and medical history forms before your visit.   If you are a new patient or returning patient for an annual visit, please follow the instructions below.

1.  Please download each form onto your computer before completing.  Your information will be lost if you do not download the forms first.
2. After completing the forms, please print and bring with you to your appointment or you can email the forms to directly to us at eyeservices@pacificeye.com.  If you are emailing your forms to us, please continue to step 3.
3. If you are emailing the forms to us, please include your first name and last name along with your date of birth on all paperwork.

REGISTRATION FORM
HISTORY FORM

If you are a new patient to our ophthalmology group, please download and read our notice of privacy practices before your appointment.

NOTICE OF PRIVACY PRACTICES

What to Bring to Your Appointment?

Each appointment visit is different.  However, in general, we request all of our patients to bring the following to each appointment:

• Photo Identification
• Insurance Card
• A list of current medications (including any non-prescriptions)
• Your current pair(s) of eyeglasses & contact lenses
• Sunglasses (to help protect your eyes after your visit in the event you are dilated)

Cataract Consultation

If you have a cataract evaluation with either Dr. Danny Lin or Dr. Scott So, please download and fill out their vision questionnaire.  This will help ours doctors best determine which lens is best for your lifestyle.  Please bring or email this form to us at eyeservices@pacificeye.com.

VISION QUESTIONNAIRE

Transferring of Medical Records

If you wish to transfer your medical records from another doctor’s clinic to our clinic before your appointment, please fill out the form below and email this to us at eyeservices@pacificeye.com. You may also fax this form to us. Our fax number is 415-923-6546.

RECORDS RELEASE FORM

Authorization to Family Member and/or Representative

Please complete the form below, if you wish to give authorization to our office to speak with anyone other than yourself regarding your care.

PATIENT CONSENT DISCLOSURE FORM

Patient Portal

Please click on the link below to access our patient portal. Through the portal, you will be able to check on upcoming appointments and pay your bills.

INTELICHART PATIENT PORTAL