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Online Forms


At Customized Vision Care, we value your time. In an effort to save you time at our office, you can complete the patient registration and health history information online prior to your appointment by downloading the forms below.

Please note there is a 24-hour cancellation policy. There will be a $25.00 cancellation fee for all missed appointments.

Patient Registration Forms

After printing and completing the forms, you can submit it to us through the following 3 options:

  1. Bring the completed forms with you at the time of your appointment
  2. Email to
  3. Fax to 866-801-4739

Also, when you come into the office, please:

  • Wear your contact lenses (if applicable)
  • Bring glasses
  • Bring in any previous eye medical records, glasses prescriptions, and/or contact lens prescriptions (manufacturer and brand)

If you have any questions, feel free to contact us at 714-529-2470 anytime.

Thank you and we look forward to seeing you soon!


Customized Vision Care
428 S. Brea Blvd
Brea, CA 92821
Phone: 714-529-2470
Fax: 866-801-4739

Office Hours

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