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Patient Forms

The team at Inland Eye LASIK knows you have a choice in providers and we are committed to making your experience with us an exceptional one. For your convenience, we’ve made our patient forms available online to help make your visit easy and convenient. Prior to your visit, please print, complete and sign the appropriate forms, and give them to our staff upon your arrival. *If you are unable to print the forms prior to your appointment that’s ok – we have copies in our office.

In addition to the forms below please be sure to bring:

  • Insurance card or proof of insurance
  • Picture I.D. with current address
  • Name of your current pharmacy, address and phone number


Serving Our Community

Serving patients in the Inland Empire, Rancho Cucamonga, Upland, Pomona, Claremont, Loma Linda, Redlands, San Bernardino, Riverside.

Rancho Cucamonga

Inland Eye LASIK
9481 Haven Ave., Suite 200
Rancho Cucamonga, CA 91730

Phone: (909) 937-9230