Click here for PATIENT HISTORY FORM
Please print, and fill out the above "Patient History Form" prior to your appointment and bring in with you at the time of your exam. We value your time and this will greatly expedite the check-in process.
If you are unable to print/fill out prior to arrival, it will be available at our front reception area.
We ask that you arrive 15 minutes early for your appointment to complete the necessary paperwork which includes:
- Eye and Health History
- HIPAA Privacy Forms
- Vision Insurance Information
- Medical Insurance Information
What to Bring
- An up-to-date list of all medications.
- If you have worn or currently wear glasses please bring them to the exam. This allows us to better assess your visual needs.
- If you wear contact lenses, please wear them in to your exam so they can be evaluated on your eye. The doctors will be able to assess your vision and the overall fit of the contact lens, and make sure you are wearing the best lens for you and your lifestyle. The more information we have about your current contact lenses (Brand, Prescription, etc), the better we are able to evaluate for optimal fit and vision.
No insurance? No problem.
- A cash-pay discount will be given to those without vision or medical insurance. Balance is due in full on day of service or before any glasses or contact lens orders are processed.
- Vision plans cover a comprehensive eye exam, glasses or contact lenses.
- We will file your insurance as a courtesy to you.
- Any remaining unpaid balance and/or non-covered services will be the responsibility of the patient and will be due on day of service or before any glasses or contact lens orders are processed.
- Most vision insurance plans are accepted: VSP, EyeMed, Superior, Vision Care Direct, UMR, PVCS, CompBenefits, and Medicaid/SoonerCare for ages 20 and under. If you have any questions about your insurance, please call our office.
- Most medical insurances do not pay for a Refraction (assessment of your vision) or glasses and contact lenses.
- A medical diagnosis such as cataracts, dry eye, diabetes, glaucoma, macular degeneration etc. is needed to be able to file for medical benefits.
- A Refraction, if requested, does require a co-pay which will be due on day of service.
- Payment for any glasses or contact lenses will be due in full before any orders are processed.
- All unpaid deductibles, non-covered services, or remaining balances are the responsibility of the patient.
- Most medical insurances are also accepted: Medicare, Medicaid, Blue Cross Blue Shield, Healthchoice, Cigna, Humana, Aetna, United Health and many more.
- Please call our office if you have any questions about your medical insurance.
- We now offer a financing option through Care Credit.
- You can print and fill out the application at CareCredit.com or you can sign up in our office.
- This can be used on any balance for either an exam, glasses, or contact lenses.
- Accept cash, check, or credit card.
If you have any questions or concerns, please feel free to call our office at 405-275-2020.