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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!

Children's Vision and Learning Questionnaire

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

Children's Head Injury History Form

Please print this form, fill it out and bring it to your next appointment if your child has had a head injury.

Adult History Form

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

Adult Head Injury or Stroke History

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

Privacy and Financial Policies

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

Release of Information Form

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

Covid Patient Waiver Form

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

Dr. Penelope S. Suter and staff 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, diagnosis and treatment of vision issues that result in reading, spelling, and other learning deficits, as well as vision dysfunction that results from autism spectrum disorder, brain injury, or other neurological compromise. Treatment may include lenses, prisms, colored filters, vision therapy, and post brain injury vision rehabilitation.