Advanced Vision Care Optometry
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Patient Forms

​​If you are a new or returning patient please fill out page 1, 2, 3 and bring to your annual GENERAL EYE EXAM/ Annual Eye Exam appointment.  

If you are coming in for brief office visits, please fill out just page 3, the Covid-19 Prescreen.

If you have already completed the patient forms sent to you via text/email, you DO NOT need to fill these forms out. 
Patient Questionaire pg1
File Size: 644 kb
File Type: pdf
Download File

Patient Questionaire pg2
File Size: 597 kb
File Type: pdf
Download File

COVID-19 Pre-Screen Questionaire pg3
File Size: 67 kb
File Type: pdf
Download File

Notice of Privacy Practices/ Information
File Size: 46 kb
File Type: pdf
Download File

Optomap Information
File Size: 451 kb
File Type: pdf
Download File

Release of Records Request (for us to get your old records/outside rx)
File Size: 33 kb
File Type: pdf
Download File

Release of Records Request (for us to release your record/rx to another office)
File Size: 32 kb
File Type: pdf
Download File

Contact Us
14140 Meridian Parkway, Suite 101
Riverside, CA 92518
Phone: 951-243-3337
​Text us: 951-243-3337 
Fax: 951-243-6868
Email: reception@avceyecare.net 
Office Hours
Tue     9:00 am - 6:00 pm
Wed    9:00 am - 6:00 pm
Thu     9:00 am - 6:00 pm
Fri       9:00 am - 5:00 pm
Sat      9:00 am - 3:00 pm
Notice of Privacy Practices
Website by Eyefinity
  • Home
  • Our Practice
  • Our Services
  • Patient Forms
  • Our Office
  • Name Brand Eyewear
  • Location
  • Request An Appointment
  • Eye Care Articles
  • Contact Lenses