Life is Beautiful. See it!
Benjamin Eye Institute
Call 310.275.5533 9201 Sunset Boulevard
Suite 709
West Hollywood, CA 90069
Patient Forms
  • New Patient Form
    New Patient Form
    New Patient Form

    Please print and fill out the New Patient Form prior to your appointment. It will help to expedite your visit with us.

  • New Patient Form (for LASIK Consultations)
    New Patient Form for LASIK Consultations
    New Patient Form (for LASIK Consultations)

    If you are coming in for a complimentary LASIK consultation, please use this New Patient Form.

  • Medical Records Release Form
    Medical Records Release Form
    Medical Records Release Form
  • LASIK Consent
    LASIK Consent
    LASIK Consent

    To view this document, please login or register.

  • PRK Consent
    PRK Consent
    PRK Consent

    Informed consent to be signed before PRK (Photorefractive Keratectomy) procedure. To view this document, please login or register.

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