Welcome to the Hollywood Vision Center.

Please call our office at (323) 954-5800 to schedule an appointment.

If you are new to our office, please fill out the first four forms below. If you wear contact lenses, please also fill out the Contact Lens Questionnaire. If you are coming to us for our Rehabilitative Vision services, please also fill out the Visual Rehabilitation Form.

We prefer that you print and fill out either the Word or PDF forms, but you may fill out the forms online if you wish. Filling out your forms ahead of time will help us to stay on schedule, and see you at your appointed time.

All of our forms are available in both Microsoft Word 97 format and Adobe Acrobat Reader 7.0. Please download the forms and fax them back to our office at (323) 954-5807 or bring them with you to your first appointment.

Please note that there is a $35.00 Late Cancellation Fee for appointments that are changed or canceled within 24 hours of your appointment time.

Hollywood Vision Center Forms Library

Microsoft Word

Adobe Acrobat 7

Web

Patient History Click Here! Click Here! Click Here!
Symptoms Checklist Click Here! Click Here! Click Here!
Financial Policy Click Here! Click Here! Click Here!
HIPAA Privacy Policy Click Here! Click Here! Click Here!
Contact Lens Questionnaire Click Here! Click Here! Click Here!
Visual Rehabilitation Form Click Here! Click Here! Click Here!

If you would like to order special effects contact lenses and already have an optometrist, please have your doctor complete our Special Effects Contact Lens Referral Form

We look forward to seeing you.

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