Call: (626) 587-0033

Request an Appointment

Home
About Us
- Meet the Doctor
- Office Gallery
Eye Care Services
Eyewear
Patient Center
Referrals
Contact Us

New Patient Form

New Patient Form

New Patient Form

New Patient Form

Mediaction

NoneYes

Allergies:

NoneYes

Do you currently wear or have worn contact lens in the past?

YesNo

Check if applicable:

MEDICAL HISTORY:

ArthritisAsthmaCancerDiabetesHeart diseaseHigh cholesterolHigh blood pressureThyroidLupus

OCULAR HISTORY:

Eye turn/lazy eyeGlaucomaMacular degenerationDiabetic retinopathyHypertensive retinopathyRetinal detachment

FAMILY HISTORY:

Eye turn/lazy eyeGlaucomaMacular degenerationDiabetic retinopathy

Please list eye conditions you experience:

Are you interested in glasses?

YesNo

Are you interested in sunglasses?

YesNo

Are you interested in contact lenses?

YesNo

Are you interested in LASIK?

YesNo

How did you hear about us?

By clicking 'Submit', you agree to Gratitude Vision Optometry's Terms of Use and Privacy Policy. See our Privacy Policy.

Thank you. We will connect with you shortly.

You are missing required fields.

Dynamic Error Description

There was an error processing this form.

Helpful Articles

surgical procedures

eye surgery co-management

ocular disease management

Understanding Computer Vision Syndrome

Diabetic Related Eye Exams

Comprehensive Eye Exam

Best Foods for Eye Health

Latisse Eyedrops

How Exercise Benefits the Eye

Keratoconus and Your Treatment Options

Overview of Common Ocular Diseases

Considering Your Face Shape When Choosing Eye Glass Frames

Pediatric Eye Exams

Contact Lens Exam

Importance of Routine Eye Exams

How Your Eyes Change with Age

Myopia Management

Eye Safety Tips

Seasonal Allergies And The Eyes

Dry Eye Treatment

Common Eye Disorders Explained

Glaucoma Testing

Eye Emergencies

Benefits of LASIK

Implantable Contact Lenses

Macular Degeneration

What to Expect During an Eye Exam

Refraction Test

Limbal Relaxing Incisions

iDesign Custom Lasik

Am I a candidate for LASIK?

LASIK Co-Management

LASIK Procedure

Cosmetic Services

Lens Technology

Surgical Co-Management

Vision Therapy: Conditions

Ocular Aesthetics

Dry Eye Advanced Diagnostic Testing

Corneal Refractive Therapy

Lumenis Optilight IPL

TearCare: Understanding Dry Eye and Its Causes

Medmont Topography

Types of Daily Contact Lenses

Multifocal Contact Lenses

Neuro-Optometric Rehabilitation

Optical Coherence Tomography

Amniotic Membranes

Low Level Light Treatment

Stellest Lenses

Urgent Eye Care

LACRIFILL® (Punctal Plugs)

Tyrvaya for Dry Eye Relief

Medical Eye Exam

Retinal Imaging Testing

Specialty Contact Lenses

EnChroma Lens Technology

Ray-Ban Meta Glasses

Post-Surgical Contact Lenses

Hybrid Contacts

Post-Concussion Syndrome

Cataract Surgery Co-Management

Nuance Audio Glasses

Colored Contacts

Glaucoma Treatment

Understanding PRK

Which Patients are Good Candidates for Premium IOL

Can Diet Reverse Diabetic Retinopathy

Eye Disease Treatment

Why Should You Consider Eyelid Rejuvenation

Overview of Visian ICL

Sidebar CTA 1

Eyecare
Services

Sidebar CTA 2

Keep
In Touch

Address:
1632 Puente Ave
Baldwin Park, CA 91706

Call Us Today:
(626) 587-0033

Hours of Operation:

Monday 9:30 am - 6:00 pm
Tuesday Closed
Wednesday 9:30 am - 6:00 pm
Thursday 9:30 am - 6:00 pm
Friday 9:00 am - 5:00 pm
Saturday 9:00 am - 5:00 pm
Sunday Closed

Let us help you

Contact Us

By clicking 'Submit', you agree to Gratitude Vision Optometry's Terms of Use and Privacy Policy. You consent to receive phone calls and SMS messages from Gratitude Vision Optometry to provide updates and information in regards to your business with Gratitude Vision Optometry. Message frequency may vary. Message & data rates may apply. Reply STOP to opt-out of further messaging. Reply HELP for more information. See our Privacy Policy.

Thank you! We will connect with you shortly.

You are missing required fields.

Dynamic Error Description

There was an error processing this form.

© 2026 Gratitude Vision Optometry. All rights Reserved | Accessibility Statement | Privacy Policy | Sitemap

Powered by:

Appointment Request

Please use the form below to request an appointment. Our team will connect with you shortly to confirm your appointment. Thank you!

Thank you. We will connect with you shortly.

You are missing required fields.

Dynamic Error Description

There was an error processing this form.

Thank You!

We've copied your review, after you click 'Publish' please paste your review by selecting 'ctrl' + 'v' into the review comments section.

Publish to Social

admin none 9:30 am - 6:00 pm Closed 9:30 am - 6:00 pm 9:30 am - 6:00 pm 9:00 am - 5:00 pm 9:00 am - 5:00 pm Closed Optometrist, Primary Eye Care, Family Eye Care, Complete Eye Care https://www.google.com/maps/place/Gratitude+Vision+Optometry/@34.064596,-117.96664,17z/data=!3m1!4b1!4m6!3m5!1s0x80c2d7ceb72b1be1:0xcedd84ce4f10fe40!8m2!3d34.064596!4d-117.96664!16s%2Fg%2F11jyglqptb https://www.yelp.com/biz/gratitude-vision-optometry-baldwin-park-4?osq=Gratitude+Vision+Optometry#reviews https://www.facebook.com/Gratitude.Vision/reviews https://goo.gl/maps/nCQbKTVrVVNkomT28 #

Login

Forgot Password?

OR

Sign in with Facebook Sign in with Google

Looking to create an account ?

Already have an account? Login

Save Search

Saved Searches

Modal title

One fine body…

Update Profile

Email

Name

Password

Confirm Password