Optometric Care of Sacramento
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Patient Forms

Welcome to our Office
File Size: 62 kb
File Type: pdf
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For patients who have never been seen at our office, this form asks for basic information such as name and address, eye related symptoms, personal medical history, medications, allergies, and family medical history.

Primary Insured member is the person whose name the insurance is under.  If you have concerns about disclosing your SSN, most insurances only require the last 4 digits.  Check with a staff member when you are here for your appointment.

Generally, when you make your appointment we have already gathered the necessary information to verify your insurance eligibility and benefits.

Update - Personal & Medical History
File Size: 63 kb
File Type: pdf
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This is for returning patients who have not completed a new history form in over 3 years, even if all the information is the same.  If any information has changed (address, phone number, personal and family medical history, medications, allergies) please document.  It is one of the HIPAA requirements.  Thank you for understanding.

Primary Insured member is the person whose name the insurance is under.  If you have concerns about disclosing your SSN, most insurances only require the last 4 digits.  Check with a staff member when you are here for your appointment.

Generally, when you make your appointment we have already gathered the necessary information to verify your insurance eligibility and benefits.
pt_wellness_screening.pdf
File Size: 171 kb
File Type: pdf
Download File

Please complete COVID-19 screening form and bring to your appointment.

Proposition 65

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WARNING: Eyeglass frames and lenses can expose you to chemicals including nickel, which is known to the State of California to cause cancer, and Bisphenol-A, which is known to the State of California to cause birth defects or other reproductive harm. 
For more information go to:  www.p65warnings.ca.gov

Contact Us
Rancho Cordova Town Center
10921 Olson Dr
Rancho Cordova, CA 95670
Phone: 916-635-1823
Office Hours
Mon    9:00 am - 5:00 pm
Tue     9:00 am - 5:00 pm
Wed    9:00 am - 5:00 pm
Thu     10:00 am - 6:00 pm
Fri       9:00 am - 5:00 pm
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Notice of Privacy Practices
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  • Home
  • Our Practice
  • Our Services
  • Patient Forms
  • Order Contact Lenses
  • Location
  • Promotions
  • Eye Care Articles
  • Privacy Notice