COVID-19  screening  requirements

Your health and well-being are of the upmost importance and we are taking measures to keep the office a safe environment for employees as well as our patients.  Anyone visiting our office will be required to go through the screening process which includes answering this questionnaire, and have their temperature prior to entering our office.  You will also be required to wear appropriate face covering and maintain a safe social distance minimum of 6 feet. 
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Online covid-19 screening FORM

COVID-19 INFORMED CONSENT FORM ADDENDUM

COVID-19 Screening Form
File Size:	423 kb
File Type:	pdf

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HIPPA COVID-19 Informed Consent Form Addendum 2021
File Size:	21 kb
File Type:	pdf

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online  appointment  scheduling  and  forms

​Please fill out the forms below and bring them to your next appointment.  If you are filling out the online versions, they will automatically be transmitted to the office.  If you choose to print fill out the .pdf version, please bring with you to your next visit.  Please fill out within 24 hours of your visit, Thank You.

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​Note to our valued patients:  We are in the process of changing to a new online appointment system that will be going into effect on July 1, 2021.  Please bear with us we make this transition, and if you have any difficulty scheduling your appointment please call the office (909) 793-2106  Thank You.  Dr. Matejka and Staff.

As of January 1, 2021 we have added the following fees:

• ​​​​​Patients will be subject to a $25 fee if they do not give 24 hours notice of cancellation or do not show for their appointment.  (15 minutes late is considered  no-show.)

• ​​​​All ​new patients and all parties of 2 or more that want to schedule on same day must pay a $20 scheduling fee/deposit that will go towards copay/product when they show. Or will go toward the no-show fee.

Check-In / Privacy Practices Form
File Size:	314 kb
File Type:	pdf

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ONLINE APPOINTMENT REQUEST

Medical History Form
File Size:	697 kb
File Type:	pdf

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Contact  Lens  re-ordering  information

Re-order Contact Lenses

EYE  CARE  INFORMATION

EYE CARE ARTICLES

EYE CARE ARTICLES

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DRY EYE SURVEY

Do you suffer from dry eyes?  Take the survey listed below and call our office.  Relief is not far away!

Dry Eye Survey
File Size:	2322 kb
File Type:	pdf

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EYEGLASS  GUIDE

Eyeglass Guide will help you better understand the many lens choices available to you.

This on-line tool will guide you through a series of questions about you, your lifestyle and your specific eyewear needs.

​At the end, you'll receive eyewear suggestions specifically tailored to meet your needs. EyeGlass Guide is brought to you by Transitions.

Helen London

View an instant demonstration of Transitions photochromic technology. See how lenses darken and fade back to clear to provide continual visual comfort and protection. Demonstrations brought to you by Transitions.

Interactive Demonstration of Transitions lenses

Interactive Demonstration of Transitions lenses in different environments

Our Services

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Need financing?  Click the CareCredit logo to apply today!

Types of Payment Accepted

We accept Cash, Debit Card, American Express, Master Card, Visa, Discover, CareCredit and PayPal.

Insurance Plans

We participate with VSP, Medicare, MES, EyeMed, NVA, VCP, Risk Management, Superior Vision, and OptumHealth Vision/Spectera. Check with our staff if you have other types of coverage.

Languages Spoken

Our staff speaks English, and Spanish.