Patient Information

PATIENT INFORMATION FORMS

Please download the forms you need to your computer, fill them out and then upload your saved forms in the area marked “File” below. Or, you can print out the forms that you need, fill them out (please print legibly) and bring the forms to your upcoming scheduled appointment.

ADDITIONAL FORMS

Name*
First Last
Phone
File*
Drop files here or

Max. file size: 256 MB.
Please upload your completed patient forms here.
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PATIENT SATISFACTION SURVEY

Provider*
Please tell us which provider you saw
Date
I had an easy time getting through to the office by phone.
When I called the office, my call was handled promptly and courteously.
My appointment was made within a reasonable time frame.
The receptionist was friendly and helpful.
The reception area was clean and comfortable.
The length of time I waited in the reception area was reasonable.
The nursing staff was friendly and courteous.
The length of time I waited in the exam room was reasonable.
I was allowed adequate time with the provider.
The provider was willing to listen to my concerns and answer my questions.
The provider explained things in a way I could understand.
The person who handled my bill was helpful and treated me with respect.
I would recommend this provider to a friend.
I would recommend this practice to a friend.
I am pleased with the overall quality of care I received.
Comments:
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FAQs

Insurance

We accept Medicare, Medicaid, Blue Cross and Blue Shield, and most other medical insurance. We are not providers for any vison plans (Vision Service Plan (VSP), Superior Vision, etc.).

What is a routine eye exam?

A routine eye examination is an exam to make sure your eyes are healthy but you are not experiencing any particular problems with your eyes. If you simply need to get eyeglasses and/or contact lenses most insurances will not cover the eye exam. Unfortunately, these rules and restrictions are set by your insurance company and we must abide by them.

Payment

We accept cash, checks, most major credit cards and Care Credit in payment for our services.

What is a refraction?

A refraction is an exam that is done to determine whether you are nearsighted, farsighted, have astigmatism and whether glasses are necessary or need to be changed. This is an essential part of any eye examination and it is very important, it identifies problems as well as helping determine why you are not seeing well. The refraction is critical in helping determine how well you can see. Unfortunately, most medical insurances will not pay for a refraction, although it is a fundamental part of a comprehensive eye exam. With that being said, please make sure you review your insurance policy carefully as some companies may provide reimbursement for this service.

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