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COVID-19 Updates

Patient Resources

Pacific Eye Institute Front DeskThe team at Pacific Eye Institute is dedicated 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.

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
  • Co-payment or Deductible (payment is due at time of service)

Online Patient Registration Questionnaire

Prior to your visit at Pacific Eye Institute, we ask that you complete the online patient registration via the link below. Patients may also complete additional paperwork prior to their visit by visiting the patient forms section on this page.

Pacific Eye Institute Online Patient Registration

Patient Forms

All Patients

Thank you for choosing Pacific Eye Institute. If you have not already completed your online patient registration, please do so prior to your visit. Patients are also welcome to complete the forms below.

COVID-19 Medical Care Consent

New Patient Packet – English | Spanish 

Notice of Privacy Practices

Notice of Non-Discrimination

Language Assistance



CareCredit healthcare credit card for better vision

There is an easier way to pay for your vision care including LASIK. We’re pleased to accept the CareCredit credit card, North America’s leading patient healthcare financing program. CareCredit lets you begin your procedure immediately — then pay for it over time with monthly payments that fit easily into your monthly budget. Whether you’re considering LASIK, need cataract surgery, or it’s simply time for new glasses or contacts, CareCredit can help you see clearer, sooner.

CareCredit Learn More

Payment Calculator

Your healthcare credit card

CareCredit is the credit card exclusively designed for healthcare services. CareCredit offers special financing on purchase of $200 or more* for healthcare procedures not commonly covered by insurance, including LASIK and Premium-IOLs. Why put off improving your vision tomorrow, when you can see clearer today?

*Subject to credit approval. Minimum monthly payments required. Visit www.carecredit.com for details.

Common Vision Challenges by Age

20 - 40
Are you tired of glasses & contacts?
Are you curious about LASIK vision correction?

Take Our Free LASIK Self-Evaluation
40 - 50
Has your up-close vision become blurry?
Do you need reading glasses to see menus, text messages, labels, etc.?
Are you experiencing cloudy, yellowed vision?
Have you been diagnosed with cataracts?

Take Our Free Cataract Self-Evaluation