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Your Optometrists in the Santa Cruz area!

Your Optometrists in the Santa Cruz area!

Home » Contact Us In Capitola and Scotts Valley » Patient Registration Form

Patient Registration Form

Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office.

This form contains confidential information and is delivered to your doctor through a secure Internet connection.