New Patient Info And Forms

Welcome to our practice!  We are really looking forward to meeting you and your family.  Yes, your initial examination will take approximately 2 to 2 1/2 hours (that is not a typo!). Follow-up visits require 30 minutes to 1 hour. Please feel free to bring water and snacks or enjoy popcorn in our movie room!  Eye drops are required on the first visit for a complete medical eye examination and refraction. A refraction is necessary to determine the best possible vision and whether medical, optical, or surgical interventions may be necessary. This is a very important part of a complete eye examination, especially for children who have been referred to rule out a disease that can cause permanent vision loss, such as amblyopia (lazy eye) or strabismus (crossed eyes). The dilating drops will temporarily blur your child's vision, and enlarge their pupils, for 4 to 24 hours, depending on their eye color. Please plan to avoid near tasks, like reading, tutoring, music lessons, or swimming outdoors immediately after this appointment  (We can send an excuse for homework!). Bring your sunglasses. If you/your child have seen previous eye doctors, we request that you send a copy of those records to our office in advance (address and fax below). Wear your contact lenses and bring all of your glasses, including sports goggles, to your appointment, and fill out the enclosed contact lens questionnaire.

Refractions are never covered by Medicare, but sometimes may be reimbursed by medical insurance plans for children less than 18 years of age. Refractions are usually covered by vision insurance plans. We will be happy to submit claims to your primary medical insurance and/or vision plan at the time of your visit, but we cannot retroactively bill your vision insurance. If our services are not covered by your insurance, we request payment in full at the time of service, including patient responsibility, deductibles or co-payments. For your convenience, we accept cash, personal checks, and MasterCard and Visa.

We encourage you to be involved in your child's health care by asking questions and/or providing the information you consider important. All information is confidential and available only to parents or legal guardians. An adult, parent, or legal guardian accompany must accompany children less than 18 years old to each appointment. Please confirm that you have completed the Patient Confidentiality Agreement portion of the Patient Information Form (yellow) you received. Your signature gives us permission to discuss you and/or your child's medical conditions only with the people you have listed.

Prior to your appointment please complete the New Patient Registration Packet Form and remember to bring your insurance card(s) and all necessary authorizations to your appointment. All new patients are asked to arrive 30 minutes early to allow our front office time to process your registration forms. 

Cancellation Policy: Effective June 1, 2017: if you fail to provide 48 hours notice prior to canceling, changing or missing your appointment, you will be charged $100.00 for each appointment. Please avoid bringing ill siblings or friends to the office and if your child has a cold or an illness, please call us to reschedule.  We understand how quickly children can become sick.

We look forward to meeting you and your family. We strive to provide excellent eye care in a  friendly,  professional environment.

Sincerely,

Kim L. Cooper, MD, Rupali Apte, MD, Jennifer Lo, OD, Leslie Hung, OD, Lita Wu, OD.

Location

1720 El Camino Real Suite 235, Burlingame, CA 94010

Phone: (650) 259-0300

Fax: (650) 259-0505

Office Hours

MON - FRI 8:00 am - 5:00 pm

SAT 8:00 am - 1:30 pm

SUN Closed

Optical Hours

MON-FRI 8:30am to 5:00pm

Sat 8:30am to 1:30pm

SunClosed

Get in Touch

Email: [email protected]

Call: (650) 259-0300