Schedule your Appointment Online
For your convenience we have implemented a web-based appointment scheduling system from 4PatientCare.
Please select one of the links below:
You may also call to schedule an appointment at (949) 753-1163 during our office hours Mon-Fri 9am to 5pm.
Please remember to bring:
Sunglasses (in case of dilation)
Previous glasses or contacts Rx
In order to serve you better and to save time at your visit, we have made our practice forms available for you. You may print out the two forms and bring them to your visit.
Patient Registration Forms (please fill out both below!)
Physician Referral Forms
Note: These forms require the free Adobe Acrobat reader
You may fill out these forms online in your web browser to print them at home.
HIPAA Notice of Privacy Practices
Abbreviated Summary of Privacy Practices:
Irvine Eye Physicians and Surgeons Inc. respects the privacy of its patients, and is committed to the protection of personal healthcare information. We follow the "privacy rule," and the "security rule", established by the Department of Health and Human Services. The "privacy rule" was created in order to provide certain standards for healthcare providers to obtain their patients' consent for the uses and disclosures of health information about the patient to carry out treatment, payment, or healthcare operations.
The misuse of Personal Health Information (PHI) has been identified as a national problem causing patients inconvenience, aggravation, and money. We would like you to know that all of our employees and doctors continually undergo training so that they may understand and comply with government rules and regulations regarding the Health Insurance Portability and Accountability Act (HIPAA) with particular emphasis on the "privacy rule."
As our patient, we would like you to know that we strive to always take reasonable precautions to protect, and secure your personal medical records, as well as your privacy. When it is appropriate and necessary, we provide the minimum necessary information to only those we feel are in need of your healthcare information and information about treatment, payment, or healthcare operations, in order to provide healthcare that is in your best interest.
We also would like you to know, that we support your full access to your personal medical records. We may have indirect treatment relationships with you (such as laboratories that only interact with physicians and not patients) and not have to disclose personal health information for purposes of treatment, payment, or healthcare operations. These entities are most often not required to obtain patient consent.
You may refuse to consent to the use or disclosure of your personal health information, but you must do so in writing. Under this law, we have the right to refuse to treat you should you choose to refuse to disclose your personal health information. If you choose to give consent in this document, at some future time you may refuse consent to all or part of your personal health information. You may not revoke actions that have already been taken which relied on this or previously signed consent.
If you have any questions, please speak with a member of our staff.