Record Release Form

Dr. Kurtbay Optometry

750 Irving Street

San Francisco, CA 94122

(Phone) 415-759-5448

(Fax) 415-759-9399 

1. All places of contact (equipment, tools, pens, chairs, tables) are disinfected between each patient visit.
2. All interactions will be as touchless as possible.
3. All frames, including frames brought for adjustment, are washed with a disinfectant solution and soap.
4. Restrooms are currently unavailable due to higher transmission risk.
5. Masks are required at this office.
6. By signing this document, I understand Dr. Kurtbay Optometry is taking measures to mitigate the risks of infection and will not hold my doctor or office staff responsible if I contract Covid-19 or any other virus.