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www.theoptometrycenter.com

Online Forms

The Optometry Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.


Patient History Form

Dowload & Print Form


Patient Questionnaire

Download & Print Form


VIP Member Registration Form - Optional

This form can be filled out to register for access to the members only section of our website. You can also sign up for our monthly newsletter to keep up on current vision issues, as well as receive special promotions and invitations to VIP events in our office. Print out this form and bring it with you to our office.  If you prefer, Click Here and register online instead!  The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form



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Phone: 510-581-1430
Fax : 510-581-7368

1575 B Street
Hayward, CA 94541

Email: rickpope2020@yahoo.com

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