DANIEL T MARTINEZ, O.D.
  • Home
  • About Us
  • Services
  • Request Appointment
  • Patient Forms
  • Eyecare Articles
  • Our Frames
  • Contact Us

Secure  Online  Patient  Forms.

Online Forms

Paper  Patient  Forms.

Please fill out the following patient information forms and bring them with you to your first visit. Signing "Acknowledgment of Receipt of Privacy Practices" on the form signifies that you have read the Privacy Policy, listed below.

  • Patient Questionnaire - English
  • Patient Questionnaire - Spanish
  • Patient Responsibility - English
  • Patient Responsibility - Spanish
  • Privacy Policy

[NOTE: This PDF requires a free plugin that may have come included with your browser. If you are having difficulties opening this file Click Here to go to Adobe's web site for Acrobat Reader.]
Picture
Location
14319 Ramona Blvd
Baldwin Park, CA  91706

Phone: 626-960-8655
              626-337-2133
Fax: 626-960-5996
Email

 Office Hours
Mon:  Closed.
Tue:  9:00 a.m. - 6:00 p.m.
Wed:  9:00 a.m. - 6:00 p.m 
Thu:  9:00 a.m. - 6:00 p.m 
Fri:  9:00 a.m. - 6:00 p.m 
​Sat: 9:00 a.m.-  2:00 p.m. 

Notice of Privacy Practices.
Website by Eyefinity
  • Home
  • About Us
  • Services
  • Request Appointment
  • Patient Forms
  • Eyecare Articles
  • Our Frames
  • Contact Us