Easily Request an Appointment at our South SF Costco office

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Appointment Request
Patient Forms
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Contact Us

Home
Appointment Request
Patient Forms
Services
Resources
Contact Us

We are located inside COSTCO on 1600 El Camino Real, South San Francisco, CA 94080

No need to have a COSTCO membership to get an exam

Appointment Request - El Camino

If this is an emergency, do not contact us via email, please go to the nearest emergency room. For quicker, easier appointment bookings, please give us a call at (650) 992-5881 or complete the form below.

Patient Name *

First

Middle

Last

Phone Number *

Phone Number Type

Cell Phone
Home Phone (Land Line)

Patient Type *

New Patient
Returning Patient

Reason for Appointment *

If other, please specify

Preference in Doctor

Preferred Appointment Time

Vision Insurance Information

I have vision insurance

I have Vision Insurance
I will be paying Out-of-Pocket

The patient is the:

Primary Insurance Holder
Dependent

Vision Insurance Provider

Primary Insurance Holder Name as it Appears on your Insurance Card (if different than above) *

First

Last

Primary Insurance Holder: Date of Birth

Anything else I would like the staff to know

How did you hear about us?

Returning Patient
Walking by the office
Friend / Family
Yelp
Google Search / Maps
Kaiser
Referral from SFO Family Eyecare
Referral from Dr. Kim Cooper
Other

Name

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Call now!