Patient Forms, Payments, and Financing
Patient Forms
Below are our practices patient forms in PDF format that we are either required to have you fill out by law or are a part of our filing structure to ensure we give you the professional service you expect. If you are a new patient, then you can save time by printing out the following forms and filling them out before your visit to us.
Please print out and bring in completed forms to your appointment
(Click on the appropriate form below to download)
Eye Examination Patient Forms
Vision Therapy Patient Forms
Insurances We Accept
Payments
You are responsible at the time of your visit for:
- Co-Payments
- $40.00 Refraction charge***
- Contact Lens fitting fee
- Digital Retinal Photography
- Supply of contact lenses
- Fees for eyeglasses
Payment is due when services are provided. We accept Cash, Checks, Visa and MasterCard. We also offer Care Credit, please ask for details
You may have health insurance that may pay a portion of your eye care bill. As a courtesy to you, we will file your claim if we are a Participating Provider for your insurance plan. We participate with most insurance carriers. Please call our office for more information. 757-890-2020.
CareCredit - The payment option for healthcare services.
Financing
Financing and Discounts Available:
- Vision Service Plans (VSP) and most medical insurance are accepted
- Senior & Military Discounts
Patient Forms
Below are our practices patient forms in PDF format that we are either required to have you fill out by law or are a part of our filing structure to ensure we give you the professional service you expect. If you are a new patient, then you can save time by printing out the following forms and filling them out before your visit to us.
Eye Examination Patient Forms
Vision Therapy Patient Forms
Insurances We Accept
Payments
You are responsible at the time of your visit for:
- Co-Payments
- $40.00 Refraction charge***
- Contact Lens fitting fee
- Digital Retinal Photography
- Supply of contact lenses
- Fees for eyeglasses
Payment is due when services are provided. We accept Cash, Checks, Visa and MasterCard. We also offer Care Credit, please ask for details
You may have health insurance that may pay a portion of your eye care bill. As a courtesy to you, we will file your claim if we are a Participating Provider for your insurance plan. We participate with most insurance carriers. Please call our office for more information. 757-890-2020.
CareCredit - The payment option for healthcare services.
Financing
Financing and Discounts Available:
- Vision Service Plans (VSP) and most medical insurance are accepted
- Senior & Military Discounts
Patient Forms
Below are our practices patient forms in PDF format that we are either required to have you fill out by law or are a part of our filing structure to ensure we give you the professional service you expect. If you are a new patient, then you can save time by printing out the following forms and filling them out before your visit to us.
Eye Examination Patient Forms
Vision Therapy Patient Forms
Insurances We Accept
Payments
You are responsible at the time of your visit for:
- Co-Payments
- $40.00 Refraction charge***
- Contact Lens fitting fee
- Digital Retinal Photography
- Supply of contact lenses
- Fees for eyeglasses
Payment is due when services are provided. We accept Cash, Checks, Visa and MasterCard. We also offer Care Credit, please ask for details
You may have health insurance that may pay a portion of your eye care bill. As a courtesy to you, we will file your claim if we are a Participating Provider for your insurance plan. We participate with most insurance carriers. Please call our office for more information. 757-890-2020.
CareCredit - The payment option for healthcare services.
Financing
Financing and Discounts Available:
- Vision Service Plans (VSP) and most medical insurance are accepted
- Senior & Military Discounts
