Jay A. Newsome, O.D. & Susan D. Mencarini, O.D.
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Patient Forms

Patient Forms

Our office has recently upgraded to an Electronic Medical Record system. Below is link to our new medical history forms. Whether you are a returning patient or you will be visiting us for the first time, please use the link to fill out/ update your forms before coming into the office. It is very important that these forms be completed before your visit.

​Thank you for your cooperation.
Medical History Form
 Contact Us:
145 N. Clovis Ave., Suite 101
 Clovis, CA 93612
 559-298-2120
email: info@cloviseyedoctor.com

Office Hours:
Mon - Fri 8:30 am - 5:00 pm


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  • Home
  • Patient Reviews
  • Our Practice
  • Our Services
  • Contact Lenses
  • Patient Forms
  • Eye Care Articles
  • Location