Patient Center

Welcome to our Online Patient Center! Here you can get information about what to expect during your visit with our team as well as important forms you can complete before your appointment to save time.

We want your visit to be as stress-free as possible. Our staff will do everything we can to make sure your experience is pleasant and convenient. If you have any questions about these forms, please don’t hesitate to contact us.

front desk and kid using a phoropter

What to Expect

When you visit our office, you will be warmly welcomed and we can answer any questions you may have about completing the paperwork so that Custom Eyes Optometry may see you. Our team will work together to evaluate your eyes and provide relevant eye care treatment information, review your vision benefits and payment options, fit you for glasses or contact lenses, and focus on exceeding all of your expectations. If at any time you have questions about the process or your specific health information, please ask.

Patient Forms

Please download and fill out each of the following forms.
HIPAA Notice of Privacy Practices is required

New Patients: Medical History Form

Returning Patients: Welcome Back Form

Notice of Privacy Practices Form

Authorization for Release of Records

kids smiling

Office Information

  • Monday
  • 9:00am - 5:30pm
  • Tuesday
  • 9:00am - 5:30pm
  • Wednesday
  • 9:00am - 5:30pm
  • Thursday
  • 9:00am - 5:30pm
  • Friday
  • 9:00am - 5:30pm
  • Saturday
  • 9:00am - 3:00pm
  • Sunday
  • Closed
We are closed for lunch on M-F from 1:15pm to 1:45pm.

949-646-4949
949-646-2533

  • 1835 Newport Blvd., Suite E-270
  • Costa Mesa, CA 92627

Electronic Health Records

Access Secure Patient Portal

Patient Forms

Please download and fill out each of the following forms.
HIPAA Notice of Privacy Practices is required

New Patients: Medical History Form

Returning Patients: Welcome Back Form

Notice of Privacy Practices Form

Authorization for Release of Records

kids smiling
I've been coming to Custom Eyes for a couple of years and my experience from front desk to Dr. Michael has been warm and welcoming. Recently, I struggled to find the "right" pair of glasses. I came in multiple times and kept changing my mind. The entire staff stepped in to help me find the perfect pair. I appreciate their support and willingness to go above and beyond. This office has a great team and I'm grateful to have found them. Thank you!
Rocio H.

Payment Options

Custom Eyes Optometry believes in providing the best value for you and your family. We have products and pricing that aims to accommodate all budgets and our office participates in most insurance programs. For patients who have little or no vision insurance coverage, flexible payment programs may be arranged. To learn more about our payment options, please call our office directly.

Our office accepts cash, check, and major debit and credit cards including MasterCard and Visa, as well as Care Credit.

Don’t forget to use your:

  • Flexible Spending Plans
  • Health Savings Accounts (HSA)
  • Medical Savings Accounts (MSA)
  • Cafeteria Plans for most of your eye care needs

Care Credit

The Care Credit card is available to help people pay for health care expenses, often with an introductory period that is interest-free. We accept Care Credit for all of our services. To learn more or apply for the card, visit Care Credit here.

Insurance

Since there are so many plans and coverage varies widely, please call us to find out if your plan covers care in our office. Our staff will verify and explain your benefits before your visit at no charge.

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How can our office help you today?

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Patient Forms
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Custom Eyes Optometry

  • 1835 Newport Blvd., Suite E-270
  • Costa Mesa, CA 92627
949-646-4949
Contact Page Request an Appointment 
 Back

Office Hours

  • Monday
  • 9:00am - 5:30pm
  • Tuesday
  • 9:00am - 5:30pm
  • Wednesday
  • 9:00am - 5:30pm
  • Thursday
  • 9:00am - 5:30pm
  • Friday
  • 9:00am - 5:30pm
  • Saturday
  • 9:00am - 3:00pm
  • Sunday
  • Closed
We are closed for lunch on M-F from 1:15pm to 1:45pm.
Request an Appointment