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Patient Forms

Downloadable patient forms that you can print and fill out before your next visit to California Oaks Vision Center of Optometry in Murrieta.

For your convenience, we have created the following pages to provide you with a list of the insurance carriers we accept at our Murrieta optometric office, as well several downloadable forms to save you time at your next appointment.

Downloadable Forms

GOOD FAITH ESTIMATES

Under the law, if you do not have medical insurance or choose to not utilize your medical insurance for specific episodes of care provided, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like office visits, medical tests and medical equipment
Your Good Faith Estimate must be made in writing at least 1 business day before your medical service or item. In the event the care is emergent or testing recommended during an office visit, your GFE will be provided at the time your additional services are offered.
You can ask your health care provider for a Good Faith Estimate before you schedule an item or service although this will be just an estimate as the exact care you need cannot be determined until your doctor evaluates you.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises

OUR NOTICE OF PRIVACY PRACTICES

By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our Web site.