TOWN CENTER OPTOMETRY
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patient  forms

Patient  Forms

Welcome_Form.pdf
File Size: 235 kb
File Type: pdf
Download File

If you wish to save some time during your visit to our office, you can download, print, and complete this form prior to your appointment. Don't forget to do the same for the other forms listed below.
medical_history.pdf
File Size: 99 kb
File Type: pdf
Download File

Receipt of Privacy Policy
File Size: 72 kb
File Type: pdf
Download File

You will also have to complete this form prior to your eye examination. This form contains information regarding your health history. Being an additional time-saver, you can download, print, and complete this form before your appointment.
You will also have to complete this form prior to your eye examination. This form contains information regarding your Notice of Privacy Practices. If you want more information, just scroll down and click  the Notice of Privacy Practices,you can download, print, and complete this form before your appointment.

Contact Us
Dr. Harold Masuda ([email protected])
1449 W. Beverly Blvd.
Montebello, CA 90640
Phone: 323-723-3937
E-mail us
      Office Hours
Mon    10:00 am - 7:30 pm
Tue     10:00 am - 7:30 pm
Thu     10:00 am - 7:30 pm
Fri       10:00 am - 7:30 pm
Sat        9:00 am - 4:00 pm
Notice of Privacy Practices     
Website Created by: Eyefinity

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  • Home
  • Our Practice
    • Testimonials
    • Retinal imaging
    • Equipment & Experience
    • Eye Care Articles
    • Laser Correction
    • Giving Back
  • Our Services
  • Patient Forms
  • CONTACT US
  • Location
  • KNOWLEDGE LINKS
  • Blogs