Elk Grove Optometry New Patient Registration

  • Welcome to Our Office

    Payment is due when services are rendered. A 50% deposit is required upon ordering glasses or contact lenses.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Medical History

  • Current Medications

    (Rx or Over the Counter)
  • Family Medical History

  • How did you first hear about our office?