At Wally Kojima, O.D. and Associates, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

New Patient Health History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

Download & Print Form


HIPAA Form – Required

Please complete this form to acknowledge the Health Insurance Portability and Accountability Act. It also has information for patients who are minors or are being fitted for contact lenses.

Download & Print Form


Download the Free AdobeReader®

Monday

10:00 am - 2:00 pm

2:30 pm - 6:00 pm

Tuesday

10:00 am - 2:00 pm

2:30 pm - 6:00 pm

Wednesday

10:00 am - 2:00 pm

2:30 pm - 6:00 pm

Thursday

10:00 am - 2:00 pm

2:30 pm - 6:00 pm

Friday

10:00 am - 2:00 pm

2:30 pm - 6:00 pm

Saturday

9:30 am - 2:00 pm

2:30 pm - 5:30 pm

Sunday

Closed

Monday
10:00 am - 2:00 pm 2:30 pm - 6:00 pm
Tuesday
10:00 am - 2:00 pm 2:30 pm - 6:00 pm
Wednesday
10:00 am - 2:00 pm 2:30 pm - 6:00 pm
Thursday
10:00 am - 2:00 pm 2:30 pm - 6:00 pm
Friday
10:00 am - 2:00 pm 2:30 pm - 6:00 pm
Saturday
9:30 am - 2:00 pm 2:30 pm - 5:30 pm
Sunday
Closed

Location

Located Inside Costco

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