Pleasanton Optometry
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  • Myopia Management
    • Myopia Management with MiSight
    • CRT-Freedom from glasses
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    • Dry Eyes
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Patient Forms

Pleasanton Optometry
1400 Santa Rita Road
Suite F
Pleasanton, CA 94566


925-846-4364
Mon    9:00 am - 6:00 pm
Tue     9:00 am - 6:00 pm
Wed    9:00 am - 6:00 pm
Thu     9:00 am - 6:00 pm
Fri       9:00 am - 3:00 pm

Save time by completing our patient forms. Please download, print, complete the forms, and bring them to your appointment.  
We look forward to your visit!
Please print and complete the Patient Information Form and the Signature page of the Privacy Practice (page 3)
before your appointment.

Patient Information
File Size: 11 kb
File Type: pdf
Download File

Notice of Privacy Practice
File Size: 35 kb
File Type: pdf
Download File

Download our Patient Forms

Pleasanton Optometry
1400 Santa Rita Road
Suite F
Pleasanton, CA 94566


925-846-4364
Mon    9:00 am - 6:00 pm
Tue     9:00 am - 6:00 pm
Wed    9:00 am - 6:00 pm
Thu     9:00 am - 6:00 pm
Fri       9:00 am - 3:00 pm

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Schedule On-Line
  • Home
  • Our Practice
    • Our Doctors
    • Payment, Policies, & Insurance
    • Promotions
    • Testimonials
  • Our Services
    • Eye Examinations
    • Contact Lens Eye Exams
    • Digital Retinal Imaging-Optomap
    • Designer Frames
  • Myopia Management
    • Myopia Management with MiSight
    • CRT-Freedom from glasses
  • Dry Eyes
    • Dry Eyes
    • Treatment of Blepharitis
  • Newsletter 2020
  • Schedule Appointment
    • Patient Forms
  • Eye Care Articles
  • Contact
    • Refer A Friend
    • Visit Our Yelp Page!