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New Patients

The Team at Coastal Skin and Eye Institute welcomes you to Coastal Skin and Eye Institute in sunny San Diego. Whether your visit is related to dermatology needs or vision correction, be assured that we are happy to serve you.

To save time at your initial appointment, please print and complete the new patient registration form shown below. As you fill it out, note questions or concerns that you’d like to discuss with the doctor. Please be sure to include a list of current medications and supplements…don’t forget to bring the form with you!

Payment must be made at the time service is provided. We accept HSA and FSA plans. Out of pocket expense may be paid by cash or major credit card. We also assist with low and zero interest financing through CareCredit.

New Patient Registration Form – Dermatology

New Patient Registration Form – Ophthalmology & Optometry

Please follow the below steps:

  • Step 1: Download the form to your device.
  • Step 2: Open the downloaded form in an Adobe Acrobat Reader.
  • Step 3: Fill the form and save it to your device.
  • Step 4: Attach the saved document to the email address below and send it to us / Print out the completed form, and bring it along when you visit us.