To schedule an appointment, please click on "COMPLETE PATIENT FORM" button below.
Once you have completed the form on our secure website, we will review the form and call you. You can also call our office to schedule an appointment. (707) 584-1233
Once you have completed the form on our secure website, we will review the form and call you. You can also call our office to schedule an appointment. (707) 584-1233
To upload a document , click on the "UPLOAD DOCUMENT(S) TO OUR SUCURE WEBSITE" button below. This is a HIPPA compliant secure website.
Work space evaluation forms for computer glasses (VDT). We have several ways to complete and submit forms to us:
- Fill-out on computer: Click on pdf download "VDT Evaluation Form (Fillable)" and fill it out. Then save the completed form to your computer, then upload it to our secure website - by clicking on the Upload Document(s) tab above.
- Print: Click on pdf download "VDT Evaluation Form (Printable) and print it. Once you have completed the form. you can Scan it to your computer, and then upload it to our secure website - by clicking on the Upload Document(s) tab above.
- Or you can it Fax# (707) 584-1387, Drop off at our office, or mail it to us at: 987 Golf Course Drive
Rohnert Park, CA 94928
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Our Privacy Practices:
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.
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.