Patient Forms
| pt_medical_form.pdf |
| pt_retinal_scan.pdf |
IT IS THE RESPONSIBILITY OF THE PATIENT TO VERIFY ELIGIBILITY AND GET ALL REFERRALS AND AUTHORIZATION INFORMATION PRIOR TO THEIR VISIT.
There are hundreds of different insurance plans. They are sometimes complex and difficult to understand. It is your responsibility, and to your advantage, to know your insurance. Please inform our receptionist whenever there is any change in your insurance. If you change insurance and we render services for which we are not providers, you are responsible for payment of those services. We will be happy to bill your insurance company for you. Please bring your insurance cards and forms to your visit.
Thank you!
The file below is required only if you have Vision Service Plan (VSP).
There are hundreds of different insurance plans. They are sometimes complex and difficult to understand. It is your responsibility, and to your advantage, to know your insurance. Please inform our receptionist whenever there is any change in your insurance. If you change insurance and we render services for which we are not providers, you are responsible for payment of those services. We will be happy to bill your insurance company for you. Please bring your insurance cards and forms to your visit.
Thank you!
The file below is required only if you have Vision Service Plan (VSP).
| pt_vsp_permission.pdf |