LOS GATOS EYE CARE
  • Home
  • OUR TEAM
    • Team of Staff
    • Ilene Polhemus, OD
    • Briana Broussard, OD
    • Maggie Enciso, OD
  • Services
  • OptiLight (Intense Pulsed Light)
  • ​Orthokeratology​
    • ​Ortho-K for Adults
  • CONTACT LENSES
  • Optical
  • Forms
  • Hours & Location
  • Contact us
    • Schedule an Appointment
  • Eye Education
  • Review us

Welcome ​to Los Gatos Eye Care!​


Below are our patient forms. You may choose to print and fill them out prior to your initial appointment. 
You will need Adobe Acrobat Reader to view these files.
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schedule an appointment

What to bring to your exam:​ 

  • Current insurance cards/information
  • Current glasses
    • ​Primary glasses
    • Sunglasses / Sports glasses
    • Computer glasses
  • Contact Lens Patients:
    • Wear contact lenses to the appointment (Insert at least 2 hours prior)
      • DO NOT wear contact lenses if you are having SEVERE problems, but please bring them in your contact lens case
    • Contact Lens Prescription or boxes, labels, vials with specifications on it
    • Name of contact lens solutions

Financial Policy


Patient Financial Policy and Expectations
File Size: 77 kb
File Type: docx
Download File

Patient Financial Policy Signature
File Size: 70 kb
File Type: docx
Download File

Authorization To Retain Credit Card Information
File Size: 81 kb
File Type: doc
Download File

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Patient History Forms


Patient History Form - Adult
File Size: 70 kb
File Type: docx
Download File

Patient History Form - Pediatric under 18
File Size: 43 kb
File Type: docx
Download File

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Records Release Authorization Form​


Records Release Authorization Form (to LGEC)
File Size: 83 kb
File Type: doc
Download File

Records Release Authorization Form (from LGEC)
File Size: 86 kb
File Type: doc
Download File

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We Would Love to Have You Visit Soon!


Hours

Mon-Thurs: 9am - 5pm
​Fri: 9am - 4pm
Saturday: 9am-1pm (closed on May 28 and June 11)

Telephone

408-377-2020

Email

eyes@lgeyecare.com
  • Home
  • OUR TEAM
    • Team of Staff
    • Ilene Polhemus, OD
    • Briana Broussard, OD
    • Maggie Enciso, OD
  • Services
  • OptiLight (Intense Pulsed Light)
  • ​Orthokeratology​
    • ​Ortho-K for Adults
  • CONTACT LENSES
  • Optical
  • Forms
  • Hours & Location
  • Contact us
    • Schedule an Appointment
  • Eye Education
  • Review us