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Patient Forms

Patient Forms

General Eye Appointments

The information below is for general eye appointments, not for LASIK or Aesthetic appointments.  If you are looking for LASIK or Aesthetic consultation information, please click here

For the convenience of our patients we have posted our patient forms on-line. Prior to your appointment, please print and complete this patient history form. You may then either bring it with you on the date of your appointment, or fax it in advance to the fax number on the form.

Thank you for choosing us!

Our physicians and staff are committed to providing you with excellent care. Since this may be your first visit to our office, we would like to make the process as stress-free as possible.

In order to make your first appointment go as smoothly as possible, please complete the enclosed forms prior to your appointment and bring them with you for your appointment.

Inland Eye Institute Patient Form

Inland Eye Institute Patient Form (Spanish)

Inland Eye LASIK Patient Form

Appointment length varies by doctor and medical condition. Please arrive 15 minutes early.
Please be prepared to spend between 1 and 3 hours in our office in order to allow for any specialized testing.

You will also need to bring:

  1. Insurance card or proof of insurance.
  2. Picture I.D. with current address.
  3. Name of your current pharmacy, address and phone number.
  4. If you are a new patient, you may be dilated and will need to bring a driver.
  5. Co-payment or Deductible (payment is due at time of service).

Please call (909) 825-3425 at least 48 hours in advance if you are unable to keep this appointment.

We appreciate your assistance and look forward to being your eye care provider.

** Should you arrive without insurance information, you could be responsible for payment at the time of service.

Additional Information

Notice of Nondiscrimination

Language Assistance

Our Locations

Inland Eye LASIK

9481 Haven Ave., Suite 200
Rancho Cucamonga, CA 91730


1900 E Washington Street
Colton, CA 92324

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