415-923-3007
2100 Webster St #214, San Francisco, CA 94115
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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)

When you first come into our office, our staff will welcome you and check you in. If you are a new patient or a patient returning for an annual visit, please fill out the two forms below.

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

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415-923-3007

2100 Webster St, San Francisco, CA 94115