New Patient Forms

Please use the links below to open the form that you wish to download and print out. You may then either bring it in with you or fax it to us at 

(661) 775-9627. Below the downloadable forms under categories, there will be links that direct you to online forms that can submitted digitally.

Please call us if you have any questions.

• General Adult Form
• General Child Form
• General Infant/Toddler Form (*to be used for children 3 years and younger)
• Supplemental Adult Strabismus Form
• Supplemental Child Strabismus Form
• Supplemental PRE Sensory Learning Program Form
• Supplemental POST Sensory Learning Program Form
• Teacher Questionnaire
• Neuro Vision Rehabilitation Patient Form

Prior to your Neuro Vision Rehabilitation Appointment, print the PDF and send it to the office via one of the following:

1. FAX back:                      661 775-9627
2. Mail back:                     28089 Smyth Drive, Valencia, CA 91355
3. Scan and email back:     c[email protected]

Thank you in advance for carefully completing our questionnaires. The information supplied will allow for more efficient use of time and will permit us to make a complete optometric evaluation of your visual system related to your specific needs. 

Thank you from the office of Dr. Carl Garbus and Dr. Lillian Chu