Patient Forms & Registration

Patient Registration

New patients please use our secure online health information portal to register. Click here to register now.

Form & Policy Downloads

We know your time is valuable so in an effort to cut down your time spent in the office filling out forms, we have included them here. Just print them out, fill them out, and bring them with you. It’s that easy!

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Nondiscrimination Notice
It is the policy of Marina Del Rey Optometry not to discriminate on the basis of race, color, national origin, sex, age or disability. Marina Del Rey Optometry has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C. § 18116) and its implementing regulations at 45 C.F.R. pt. 92, issued by the U.S. Department of Health and Human Services. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities.

Download the Nondiscrimination Notice to read more.