Anne K. Matsushima, O.D., Inc.
Anne K. Matsushima, O.D.
​Richard H. Miyasaka, O.D.
​James K. Miyasaka, O.D.
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Patient Forms

Patient Information
File Size: 74 kb
File Type: pdf
Download File

Medical History Questionnaire
File Size: 63 kb
File Type: pdf
Download File

Notice of Privacy Practices
File Size: 31 kb
File Type: pdf
Download File

Please complete the forms listed above and bring them with you to your exam.  You may also fax or email these forms to our office ahead of time.  If you are a contact lens wearer, please bring in any boxes or old prescriptions so we can verify the type of lens you are wearing during your exam.

 Fax: (808) 737-2307
 Email: office.drmod@gmail.com



 Mahalo,
 Dr. Miyasaka & Staff
Contact Us
Anne K. Matsushima, O.D., Inc.
3615 Harding Ave., Suite 208
Honolulu, HI 96816
Phone: 808-734-8870
Fax: 808-737-2307
email: office.drmod@gmail.com
​Richard H. Miyasaka, O.D.
​James K. Miyasaka, O.D.
Office Hours - APPOINTMENT ONLY | Updated 5/11/20
Mon    9:00 am - 5:30 pm
Tue     9:00 am - 1:00 pm
Wed    9:00 am - 5:30 pm
Thu     BY APPOINTMENT ONLY
Fri       9:00 am - 5:30 pm
Sat      9:00 am - 1:00 pm
Notice of Privacy Practices
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