You can prepare for your University Eye Center at Ketchum Health appointment in advance by completing the web registration or by printing and completing the necessary forms provided below. If you have any questions, please contact us at 323.234.9137 (phone) or 323.235.6203 (fax).
Patient Web Registration
Save time and paper by completing our online Patient Web Registration.
Patient Forms
English Version
Required for all patients
- Patient Information Form
- Health History & Lifestyle Questionnaire
- Financial Policy
- Patient Bill of Rights and Responsibilities
- Notice of Privacy Practices
- Patient Rights under the Federal No-Surprises Act of 2022
Specialty forms
- Low Vision Patient Information Form
- Pediatric Health History and Lifestyle Questionnaire
- Consent Form for Treatment of Minors
- Convergence Insufficiency Symptom Survey
- Medical Acronyms
Spanish Version
Formas para todos los pacientes
- Información del Paciente
- Historia Médica y Estilo de Vida
- Politicas Financieras
- Derechos de los Pacientes
- Aviso sobre prácticas de privacidad