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EYEcenter Patient Check In Forms

Thank you for choosing to fill out paperwork prior to your appointment. Doing so will allow us to serve you more efficiently, making your appointment faster and safer for you and our staff.

If you have any questions, feel free to contact us at 916-726-1818.
Thank you again for your cooperation. We look forward to seeing you at your appointment.

Patient Check-In Forms

Step 1 of 4

  • MM slash DD slash YYYY
  • I confirm that I am not currently presenting or have had in the past 10 days any of the following symptoms of COVID19 listed below:
    • Fever
    • Shortness of breath
    • Dry Cough
    • Runny Nose
    • Sore Throat
  • (Initials)
  • (Initials)
  • (Initials)

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