Embedded Files
These documents are here for your information. I do not need for you to print or fill anything out, unless I specifically asked you to. By law I am required to show you the Notice of Privacy Practices and during your exam you will sign one line saying that you have been given a copy of the Notice of Privacy Practices.
Notice of Privacy Practices
Notice of Privacy Practices
CA Notice-of-Privacy-Practices-English.pdfNotice of Privacy Practices (Spanish)
Notice of Privacy Practices (Spanish)
CA Notice-of-Privacy-Practices-Spanish.pdfRelease of Medical Records Form (for Livermore Pearle Vision)
Release of Medical Records Form (for Livermore Pearle Vision)
Med Rec Release.pdfRelease of Medical Records Form (for Ceres Walmart)
Release of Medical Records Form (for Ceres Walmart)
Med Rec Release - Ceres.pdfPatient History Form
Patient History Form
Comprehensive Hx.pdfGoogle Sites
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