New Patient Intake Form

NOTE: This form is for patients who have reached out to our office and have already been assigned a tentative appointment. 

If you do not have a tentative appointment please call our office prior to filling out the form below. 

Thank you for your interest in becoming a patient of Sequoia Eye Group! 
 
All new patients must complete and submit this electronic form no less than 72 business hours prior to visiting our office. If there is any reason you cannot fill out this form please let our office know. 
 
We understand that providing this information before your visit can be challenging and we appreciate your efforts. Providing accurate information to us in advance of your visit allows our office to streamline your experience. For example, our office prioritizes financial transparency with regard to the costs of healthcare, and having your information will allow our insurance team to help provide details about the upfront copays determined by your healthcare policy.
 
Thank you and we all look forward to welcoming you to our eye care family!
 
— Sequoia Eye Group
 
Note: The information you supply is confidential and used for internal purposes only.
Online New Patient Intake Form