Forms

PATIENT FORMS

NEW PATIENTS should bring their most recent pair of glasses and contact lens prescription (or alternatively contact lens boxes or blister packets), if applicable, with them to their appointment.  They should expect to have their eyes dilated at the time of the visit.  Sunglasses will be provided if needed at the end of the exam.  Please be advised that some patients may experience difficulty driving with their eyes dilated so it may be advisable to bring a driver.

THE FOLLOWING FORMS should be carefully read and filled out prior to the initial office visit.  The completed forms along with a photo ID and health insurance card, if applicable, should be presented upon arrival.  New patients are also responsible for providing a referral form from their primary care physician before the exam if required by their health plan to avoid higher out-of-pocket expenses they would otherwise incur for the visit:

CONTACT LENS PRICING & POLICY
Please refer to the Routine Vision Policy above.
  • Contact Lens Fitting & Prescriptions (soft contact lenses only)
MEDICAL RECORDS RELEASE
Upon receipt of the completed and signed Authorization for Disclosure Form and payment for any applicable medical records fees, our office requires 48 hours prior to any actual release of medical records.
Most health insurance plans, including Medicare, are accepted.

Recent Posts