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Patient Forms

We are happy to provide you with HIPAA-secure forms that you can fill out right on your computer. No printing or handwriting necessary! Simply find the form you need below, click on it and the form will open in a new window. Fill it out right on your computer and hit the “submit” button at the bottom of the form. We will receive your form through our HIPAA-secure email and have it ready to go before you arrive for your appointment. It's that easy!

Extended Children's Questionnaire

Please fill out the extended form if your child has trouble with reading, homework or struggles in school.

Medical Release Form

Please print this form, fill it out and bring it to your next appointment.

To our new patients: Please take the time to fill out our “Office Financial Policy” form, as well as our “Consent for Use or Disclosure of Health Information.” This will help expedite your visit in our office.

The optometrists and staff at Dr. Penelope S. Suter’s office are proud to serve patients in Bakersfield as well as surrounding communities such as Arvin, Delano, Frazier Park, Lake Isabella, Lamont, Lancaster, Palmdale, Porterville, Shafter, Taft, Tehachapi, Visalia, Wasco and many more. Our services include, but are not limited to, general optometry, vision therapy, diagnosis and treatment of eye disease and conditions and the treatment of vision issues that result from brain injury or other neurological compromise.