BERKELEY OPTOMETRIC GROUP
  • Home
  • Our Practice
  • COVID-19 INFO
  • Our Services
  • Patient Forms
  • Location

Patient  History  Form

Patient Forms


Patient Health History Form
File Size: 21 kb
File Type: pdf
Download File

Please fill out this form before your next eye examination at our optometry office.

​This will allow the optometrists at the Berkeley Optometric Group to be able to serve your in a more timely manner.
Contact Us
2414 Shattuck Avenue
Berkeley, CA 94704
Phone: 510-843-1228
Fax: ​510-843-2080

Office Hours
Mon    9
:00 am - 3:00 pm
Tue     9:00 am - 3:00 pm
Wed    9:00 am - 5:00 pm
Thu     9:00 am - 5:00 pm
Fri       9:00 am - 5:00 pm
Sat      
9:00 am - 3:00 pm
Sun     Closed
By Appointment Only

​Notice of Privacy Practices
  • Home
  • Our Practice
  • COVID-19 INFO
  • Our Services
  • Patient Forms
  • Location