ROHNERT PARK OPTOMETRIC CENTER
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Patient  Forms

When you make your appointment with our front office, we will instruct you on which forms to complete. Please ensure that you complete each form in its entirety. Your cooperation helps us ensure that your appointment goes smoothly and we do not have too many people in the office at one time. We are more than happy to help you complete your paperwork; just give us a call! Please fax or mail the forms after you complete them. If you are a new patient, please complete the "Complete" and "Privacy Practices" forms. If you have been to our office before, please use the form we asked you to fill out over the phone.
Complete Form
Complete Form.pdf
File Size: 215 kb
File Type: pdf
Download File

Privacy Practices
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We want to ensure that you have access to our privacy practices. You may view them here. (clickable) Our privacy practices let you know how we use your information in our office and are similar to the privacy practice information you would receive at any healthcare facility. Please print your name, sign, and date on this form so that we know that you received this information.
Privacy Practices.pdf
File Size: 113 kb
File Type: pdf
Download File

Partial Form
Partial Form.pdf
File Size: 137 kb
File Type: pdf
Download File

Contact Us
987 Golf Course Drive
Rohnert Park, CA 94928
Phone: 707-584-1233

Office Hours
Mon    10:00 am - 5:30 pm
Tue     10:00 am - 5:30 pm
Wed    Noon - 7:30 pm
Thu     10:00 am - 5:30 pm
Fri       10:00 am - 2:00 pm
Please note that these hours may vary.

Notice of Privacy Practices
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  • Home
  • Our Practice
    • Eco commitment
    • Privacy Notice
  • Patient Forms
  • Our Services
  • Eye Care Articles
  • Optical Boutique
  • Location