Location inside COSTCO on 451 South Airport Blvd, South San Francisco, CA 94080 No need to have a COSTCO membership to get an exam Appointment Request - Airport Blvd.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) 589-3128 or complete the form below. Please enable JavaScript in your browser to complete this form.Patient Name *FirstMiddleLastPhone Number *Phone Number TypeCell PhoneHome Phone (Land Line)Patient Type *New PatientReturning PatientReason for Appointment *Choice 1Eye Exam (includes prescription for eyeglasses)Contact Lens Exam (includes prescription for eyeglasses)Health Check (office visit)Myopia ControlOtherIf other, please specifyPreference in DoctorFirst Available DoctorDr. Kenneth Chiu, O.D.Dr. Teresa Wu, O.D.Dr. Khanh V. Dao, O.D.Dr. Ellen Ong, O.D. FAAODr. Jacqueline Mai, O.D.Dr. Linh H. Nguyen, O.D.Dr. Michael Chin, O.D.Dr. Rebecca Stapornkul, O.D.Dr. Saya Hayashi, O.D.Dr. Tsungming Tony Hung, O.D.Dr. Vinoja Kamaleswaran, O.D.Preferred Appointment TimeVision Insurance InformationI have vision insuranceI have Vision InsuranceI will be paying Out-of-PocketThe patient is the:Primary Insurance HolderDependentVision Insurance ProviderChoice 6VSPSpectera / UnitedHealthcare VisionEyeMed (for COSTCO EMPLOYEES Only)My Vision Insurance Provider is not listed here so I will pay out-of-pocket and submit for reimbursement myself.Primary Insurance Holder Name as it Appears on your Insurance Card (if different than above)FirstLastPrimary Insurance Holder: Date of BirthMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Anything else I would like the staff to knowHow did you hear about us?Returning PatientWalking by the officeFriend / FamilyYelpGoogle Search / MapsKaiserReferral from K & K OptometryReferral from Dr. Kim CooperOtherEmailSubmit