Chan Family Optometry

360 Sierra College Dr. Ste. 100

Grass Valley, CA 95945 US

(530) 273-3190

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All patients receive 20% OFF second pair of complete glasses!

Online Forms

Please complete these forms as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals you have regarding your eye health or vision on the form. Click on the corresponding form name to download.


New Patient Forms

Eye Symptom Questionnaire

Financial Responsibility

Health History

HIPAA Privacy Practices (No signature needed. Only for your information.)

Release of Records


Returning Patient Forms

Financial Responsibility

Eye Symptom Questionnaire

Contact Lens General Information Handout