Home » Contact Us » Patient Registration Form

Patient Registration Form

Patient Forms (Downloadable and Fillable)

We are honored that you have chosen Milpitas Optometric Group for your eyecare needs.  In order to expedite your registration process,  please complete the patient form below.  Once complete, please print the form and bring the printed copy with you to your scheduled appointment.  Adobe Acrobat Reader® is required to view, fill in and print these forms.  A free download is available here: Adobe Acrobat Reader®

Download Patient Form Here

 

Please contact our staff at (408) 263-2040 if you have any questions regarding the forms above.  We look forward to seeing you soon.

*These forms are for new patients or someone who has not had an eye exam here in the past three years.