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Patient Forms & Fees

Please bring insurance ID cards and photo ID with you for every visit, plus your current eyeglasses or contact lens prescription if available. ​

Medical Records Request:

South Bay Family Eye Request for Medical Records

A signed medical request form is required to transfer medical records to or from our office. Please download the form and type in your answers as completely as possible before printing and signing the form. Then, you should send the form to your prior doctor if you want their records sent to us or return the form to our office by fax or email ( if you want our medical records sent to your medical provider.

South Bay Family Eye Fees

Reschedule Missed Appointment - $25

Dictated Visit Summary - $10

DMV or School Forms - $10

Copy of Complete Medical Record - $20

FMLA or Disability Forms - $20

Social Security/Legal Documents - varies by statute

For most documents, South Bay Family Eye will complete the request within one week (5 business days). South Bay Family Eye will replace eyeglass or contact lens prescriptions at no charge, but requires 48 hours advance notice to retrieve and verify the prescription.

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