DRY EYE

NEUROLENS®

OPTILIGHT IPL

APPOINTMENT

VUITY®

UPNEEQ®

Consultation Request
Patient Information
Insurance Information
Dilation Information
Health History

Financial Policy
Consent to Treat Minor
Acknowledgement of Privacy Practice
Authorization to Disclose Health Information
Order Contacts
Dry Eye Questionnaire

From the list above, please click on the form you would like to complete and submit to the office!

If you want paper forms, Please call or email office!

Request Appointment

Office Hours

Mon

9:00 - 5:30

Tue

9:00 - 5:30

Wed

9:00 - 5:30

Thu

9:00 - 5:30

Fri

9:00 - 5:30

Sat

10:00 - 2:00

Sun

Closed

13768 Roswell Ave.
Suite 208
Chino, CA 91710

Map it!

Call (909) 627-2020

Email Us info@shameemkhanod.com

Dr. Shameem Khan Optometrist, Inc. 13768 Roswell Ave. Suite 208 Chino, CA 91710 Phone: (909) 627-2020