Patient Forms
| Patient History Form - English |
Please take a moment to download and complete the above Patient History Form before your appointment. Thank you!
| Patient History Form - Spanish |
| Hippa Acknowledgement Form |
| Patient History Form - English | |
| File Size: | 350 kb |
| File Type: | |
| Patient History Form - Spanish | |
| File Size: | 357 kb |
| File Type: | |
| Hippa Acknowledgement Form | |
| File Size: | 355 kb |
| File Type: | |
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We are ADA compliant. Please click here to view the ADA accessibility policy.
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Dr. Anacleto "Nick" Gutierrez,O.D., MPH
Contact Us 2615 Capitol Avenue Sacramento, California 95816 Phone: 916 447.2020 www.drgutierrezoptometrist.com |
Office Hours
Mon 9:00 am - 5:00 pm Tue 9:00 am - 5:00 pm Wed 9:00 am - 5:00 pm Thu 9:00 am - 5:00 pm Fri 9:00 am - 5:00 pm Saturday by appointment |