415-923-3007
2100 Webster St #214, San Francisco, CA 94115
request
an appointment

Forms

Before Your Visit

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

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

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 form first.
  2. After completing the form, please print and bring with you to your appointment or you can email the forms to directly to us.  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.

REGISTRATION FORM
HISTORY FORM

Please download and read the form below before regarding our clinic’s Privacy Practices:

NOTICE OF PRIVACY PRACTICES

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.

Athenahealth Patient Portal

Search our website

contact us

415-923-3007

2100 Webster St, San Francisco, CA 94115