Yeh and Yu Optometry
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patient forms

If you are new to our practice, please feel free to fill out, print, and bring the following forms to our office before your comprehensive eye exam. 
​
If you are a previous patient, you only need to fill out the lifestyle questionnaire.

We provide all these forms in hard-copy in our office. Please give us a call if you have any questions.

Lifestyle Questionnaire
File Size: 120 kb
File Type: pdf
Download File

New Patient Info Sheet
File Size: 120 kb
File Type: pdf
Download File

Receipt of Privacy Practices Notice
File Size: 112 kb
File Type: pdf
Download File

Notice of Privacy Practices*
File Size: 140 kb
File Type: pdf
Download File

*You do not need to print and bring the Notice of Privacy Practices. This is for your viewing and records.
Contact Us
8637 Baseline Road
Rancho Cucamonga, CA 91730
Phone: 909-466-7580
Fax:​ 909-912-8760

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Office Hours
Mon    9:00 am - 5:00 pm
Tue     9:00 am - 5:00 pm
Wed    9:00 am - 5:00 pm
Thu     9:00 am - 5:00 pm
Fri       9:00 am - 5:00 pm
Sat      Closed

We close for lunch from 1-2 pm
Insurances Accepted
We participate with VSP, Medicaid, MES, Eyemed, IEHP, Davis Vision, Spectera, March Vision, Healthy Families, and NVA. We offer a discount for Medicare patients. This is not a complete list. Please call our office to check if your insurance is not listed.
Notice of Privacy Practices
Website by Eyefinity
  • Online Appointment
  • Order Contacts
  • COVID 19 Announcement
  • About Us
  • Resources
    • What's New?
    • Patient Forms
    • Refraction Errors
    • FAQ