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New Patient Forms

The below questionnaire is to be submitted online prior to your appointment. Carefully preparing this form in advance will greatly increase the efficiency of your Consultation and the information it provides you.

Please review the following form. You do not need to print it. We will have a copy for you to sign in our office. If you have any questions, our staff will be happy to answer them in advance of your appointment.

If you are interested in our privacy practices, click below:

LASIK

PRK

Implantable Contact Lens (ICL)

Refractive Lens Exchange (RLE)

Cataract Surgery

Light Adjustable Lens (LAL)

Other

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Pasadena Office Opening January 2025

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Dr. Shamie, Dr. Hura & Dr. Maloney Named 2024 SuperDoctors

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Kylie Jenner’s LASIK @ Maloney-Shamie-Hura Vision Institute

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Peyton List’s EVO Surgery at Maloney-Shamie-Hura Vision Institute

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Accessibility: If you are vision-impaired or have some other impairment covered by the Americans with Disabilities Act or a similar law, and you wish to discuss potential accommodations related to using this website, please contact our Accessibility Manager at (310) 882-6365.