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The Maloney-Shamie Vision Institute is an Authorized FDA Study Center for vision correction technology.

Patient Forms

New Patient Forms

The following forms can be downloaded to your computer and printed at home. Carefully preparing these forms in advance will greatly increase the efficiency of your Consultation and the information it provides you.

  1. New Patient Questionnaire (select one)
    1. Vision Correction Questionnaire
    2. Cataract Questionnaire
    3. General Medical Questionnaire
  1. Financial Policy

Please review the following form. You do not need to print it. We will have a copy for you to sign in our office. If you have any questions, our staff will be happy to answer them in advance of your appointment.

  1. Physician-Patient Arbitration Agreement

If you are interested in our privacy practices, click below:

  1. HIPAA Notice of Privacy Practices

Schedule a Consultation today! Find out if you are a candidate by calling or emailing today.

Call us at 310.882.6365 or click here to schedule an appointment online »

Want to see it all, without your glasses? To schedule your Complimentary Consultation, call us at or click here to schedule an appointment online.


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