SHORELINE OPTOMETRY
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Patient  Forms


Below are our forms for new patients, babies participating in the InfantSEE program, and forms to release records to our office, or to have us release records to another office.  Save time at your visit by printing and filling out the appropriate forms ahead of time and bringing them to your appointment.

New  Patient  forms

medical_history_form_updated.pdf
File Size: 175 kb
File Type: pdf
Download File

welcome_form_2022.pdf
File Size: 71 kb
File Type: pdf
Download File

HIPAA Consent Form
File Size: 40 kb
File Type: docx
Download File

InfantSEE History Form
File Size: 32 kb
File Type: pdf
Download File

record  release  forms

ror_to_shoreline_optometry.pdf
File Size: 49 kb
File Type: pdf
Download File

ror_from_shoreline_optometry.pdf
File Size: 49 kb
File Type: pdf
Download File

notice  of  privacy  practices

hippa_notice1.pdf
File Size: 143 kb
File Type: pdf
Download File

Contact Us
419 N. Shoreline Blvd
Mountain View, CA 94043
Phone: 650-967-5789
E-mail: contact@shorelineoptometry.com


Office Hours
Mon    8:00 am - 12:15 pm, 2:00 pm - 5:00 pm
Tue     8:00 am - 12:15 pm, 2:00 pm - 5:00 pm
Wed    8:00 am - 12:15 pm, 2:00 pm - 5:00 pm
Thu     8:00 am - 12:15 pm, 2:00 pm - 5:00 pm
Fri       8:00 am - 1:00 pm
Sat & Sun: Not Open
Picture

Notice of Privacy Practices
Website by Eyefinity
  • Home
  • About
    • Our Practice
    • Our Services
    • Location & Hours
  • Patient Forms
  • Insurance Plans
  • Schedule Appointment
  • News & Articles
    • Practice News
    • Eye Care Articles
  • Optical Boutique
    • Lens Options