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Patient Intake | West Hills Vision Care

Patient Intake

Please download our Patient Intake Form here and follow the instructions below:

Step 1: Complete the form by filling in all required fields.
Step 2: After you complete the form, you may either

  • Print and bring the completed form with you to your first appointment, or
  • Submit the completed form via email to

*If your PDF opens in a browser instead of Adobe Acrobat, please save your completed PDF by right-clicking “save as” so you can attach your form to your email. 

Please don’t hesitate to contact us at if you have any questions!