Quick & Easy Online Forms

Simply fill out our patient forms from your computer or smartphone then click submit to securely send your forms to our practice.  If you prefer to print our forms, PDF versions are found below.

Adult Registration Forms

Pediatric Registration Forms

Frequently asked questions

I'm a new patient, what do I need to know?


Dear Patient, We are pleased you have chosen Peninsula Eye Physicians for all your eye care needs. Here is some information you may find helpful:

  • Parking is available for $1.00 per hour ($2/hr Starting July 1st) in the garage under our building. To reach the parking garage go north on San Mateo Drive, make a right onto Baldwin Avenue and another right onto Ellsworth Avenue. You will make a right into the first driveway you see - this will be the Mills Square driveway. You may also choose metered parking on the street.
  • You should arrive a few minutes earlier than your scheduled time so that we may photocopy your insurance card and answer any questions you may have. If you are here to get new glasses, you can shop in our friendly optical department before your appointment.
  • Please bring the following items to your appointment: Your referral, completed registration forms, insurance card, a list of medications you are currently taking and all your glasses that you currently use. If you wear contacts lenses, please bring any available information such as the packaging or prescription.
  • Allow enough time for your appointment – usually 1 to 1½ hours (depending on what you are being seen for).
  • During your visit you may have dilation drops placed in your eyes to help the doctor examine you. We will provide you with disposable sunglasses as you check out if you need them. However, if you are unsure of your ability to drive while your eyes are dilated, you may want to bring a driver with you.
  • We are participating providers with many insurance plans and are happy to file claims to your insurance for covered services. For non-covered services, such as refraction (see below) or optical purchases, you will be responsible for the total amount.
** The refraction is the portion of the exam that determines your prescription for glasses. This enables you to receive a written eyeglasses prescription that is valid for 2 years. In general, most insurance companies consider this to be a noncovered service. Therefore, we ask that you pay for the refraction at the time of your appointment. The fee for the refraction is $65.00. We will bill the entire amount of your exam to your insurance and if the refraction is covered, we will reimburse the cost of the refraction to you. (Exception: Vision Service Plan and insurances that specifically state on the authorizations that refractions are covered, there will be no charge to you). Although the refraction is an important part of your exam, you may choose whether or not to have the refraction performed.
  • For your convenience we accept all major credit cards.
Again, we thank you for choosing our practice and look forward to serving you.




What insurances do you accept?


Here is a small list of insurances we are on:

  • Aetna PPO
  • Healthnet HMO/PPO
  • Blue Cross HMO, California Care
  • UniCare PPO
  • Blue Shield HMO*
  • Great West Life Ins. PPO Plan
  • UnitedHealth Care PPO/POS
  • Blue Shield PPO
  • New England Life Insurance PPO
  • Admar Network*
  • Blue Shield 65
  • The Guardian
  • PruCare
  • Principal Mutual PPO
  • Standard Vision Service Plan
  • Aetna MC
  • MIlls Peninsula Medical Group
  • Medicare
  • Aetna Select/Senior Choice*
  • Pacific Care HMO




Can you help me understand the different types of insurance?


PPO - plan encourages you to choose doctors, hospitals, and other providers that participate in the plan. They do this by increasing the portion of the bill they pay if you stay “in network.” You may choose to go “out-of-network” at any time, but if you do, you’ll have to pay a higher percentage of the provider’s bill. Other than physician office visits and emergency care, services must usually be authorized by the PPO before you receive them. Some PPOs have a primary care physician who is responsible for coordinating your medical care.

HMO - Health Managed Organization - plan requires that you select a primary care physician (PCP) within the HMO provider network. Your PCP is responsible for meeting your health care needs, either by taking care of you directly or by referring you to other providers (such as specialists). As long as you see your PCP or have an authorized referral to another provider, your out-of-pocket cost is usually a relatively small copayment per visit. But if you chose to go to another provider without a referral--whether or not the providers are in the HMO network--you'll have to pay 100% of the provider's bills. The exceptions are true emergency situations for which you are covered by the plan.

EPO - Exclusive Provider Plan- is very similar to an HMO. With an EPO, you must select a primary care physician or physician gatekeeper who will be responsible for meeting your health care needs. In most EPO plans, as with an HMO, if you choose to go out-of-network, you'll have to pay 100% of the provider's bills.

POS- Point Of Service - This is a variation of the HMO and EPO plans and is often described as an open-ended HMO. As with an HMO, you must pick a primary care physician within the network. You pay least when you receive services from your PCP or through an authorized referral to another provider. But unlike an HMO, you may opt out of the network. If you opt out you'll be responsible for paying a portion of the provider's bills.

Please check your Medical Insurance if you want your Refraction covered. Most Medical Insurance does not cover Refractions*. (*Eye examination for glasses, they don't cover it because it is not a medical benefit)

But if you do have Vision Insurance, please let us know in advance on what the plan is. There are some plans that do require prior authorizations or special arrangements to be made in advance. If you are a member of VSP or Vision Service Plan. You can check your eligibility online.

If you do have another coverage not listed. Please call your plan or look at the listing of providers in your medical plan book. If you are still in need of help please call: 650-342-7474




How can I refill my prescription?


The easiest way to get a refill is to ask your pharmacy to submit the request to us. Given the volume of requests per day, we ask that patients expect 3 business days for prescription requests or refills. Refills or pharmacy orders requested Friday afternoon may be filled the following week. We understand that many medical offices charge for filling out forms, but we currently do not as a courtesy to our patients. However, we reserve the right to charge for extraordinary requests. Please allow our physicians 3 business days to fill out forms left at the office. If your physician is out of town, please allow for a longer time frame or indicate to the staff that your paperwork may need sooner attention. Our office will do our best to accommodate your request. We ask that you enclose a self-addressed stamped envelope. You may also pick up your paperwork from the office after being notified.




How does PenEye Physicians protect my personal informations?


Peninsula Eye Physicians takes every possible step to ensure your personal information is kept private. You can read our full Privacy Policy by clicking here.





Peninsula Eye Physicians

101 So San Mateo Dr. Ste. 310

San Mateo, Ca 94401

For Life-Threatening Emergencies Call 911
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