Dear Terry & Kim Eye Institute Patient:

Welcome to the Terry & Kim Eye Institute! Thank you for allowing us the opportunity to serve your eye care needs. We value all of our patients and are committed to providing you with compassionate and advanced eye care services.

Please take a few moments prior to your appointment to review and complete the registration forms. We ask you that you bring the completed forms to your appointment along with your insurance card.

Please arrive 10 minutes early to your appointment. We appreciate your assistance.

Please click on the tabs below to download the forms that will need to be completed in order for us to assist with your care.

Patient Registration Form

HMO ABN Form

Patient Medical History - English

Patient Financial Responsibility

PPO ABN Form

Patient Medical History - Korean

HIPPA Form

Medicare ABN Form

Patient Medical History - Spanish

Contact Lens Consent & Agreement

Choice Plan Membership

We have two eye service membership plans for our patients who do not have any health insurances or have health insurances that we are not part of. These membership plans are excellent options for those who want to supplement their current health insurances or would like to take care of their eye health while they search for a health insurance. You get to choose one of our well-trained ophthalmologists as your primary eye doctor for the next 12 months.

Free-Choice Eye Service Membership

$500 per year
up to 2 medical visits/consultations
All Office Diagnostic Testing (Optical Coherence Tomography, Corneal Topography, Visual Field, Intraocular Lens Biometry, Refraction, Corneal Pachymetry, Ultrasound A-Scan, and Ophthalmic Photos)
Does Not Include Any Procedures or Surgeries

Premier-Choice Eye Service Membership

$950 per year
up to 4 medical visits/consultations
up to 2 postop visits
All Office Diagnostic Testing (Optical Coherence Tomography, Corneal Topography, Visual Field, Intraocular Lens Biometry, Refraction, Corneal Pachymetry, Ultrasound A-Scan, and Ophthalmic Photos)
Does Not Include Any Procedures or Surgeries
10% Off on Physician Fee for Procedures and Surgeries (Discount Does Not Apply to OR and Anesthesia Fees)

Terry & Kim Eye Institute Patient Portal Access

With Terry & Kim Eye Institute Patient Portal, you can connect with your doctors through secure intramail and update your medication, pharmacy, and demographics informations. Please click on the tab below to enter your Patient Portal. If you don't have your User ID and Password for Patient Portal, please ask the front desk receptionists for more information.

Terry & Kim Eye Institute Patient Portal